Sakata N, Yasui M, Kawa K
Department of Pediatrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
Int J Hematol. 2001 Jul;74(1):90-4. doi: 10.1007/BF02982556.
We encountered 2 patients with pneumococcal arthritis following bone marrow transplantation (BMT). Both patients received grafts from unrelated human lymphocyte antigen (HLA)-matched donors and had suffered from chronic graft-versus-host disease (GVHD). One, a 10-year-old boy, suffered from Epstein-Barr virus-related lymphoproliferative disease (EB-LPD) and received oral 6-mercaptopurine and methotrexate to manage lymphadenopathy. Twenty-four months after BMT and 7 months after the onset of EB-LPD, pneumococcal arthritis occurred in both knee joints. The other patient, a 10-year-old girl, received multiagent immunosuppressive therapy for her chronic GVHD. At 51 months following BMT, pneumococcal arthritis occurred in her left knee joint. Chronic GVHD of the skin delayed the recovery from the arthritis in both patients. This complication is quite rare but can be very serious, in regard to the patient's performance status following BMT. Although vaccination against pneumococcus or preventive antibiotics should be administered to high-risk patients, early diagnosis and treatment may be the best strategy for pneumococcal arthritis.
我们遇到了2例骨髓移植（BMT）后发生肺炎球菌性关节炎的患者。两名患者均接受了来自人类淋巴细胞抗原（HLA）匹配的无关供体的移植物，并患有慢性移植物抗宿主病（GVHD）。其中一名10岁男孩患有与爱泼斯坦-巴尔病毒相关的淋巴增殖性疾病（EB-LPD），并接受口服6-巯基嘌呤和甲氨蝶呤治疗淋巴结病。BMT后24个月和EB-LPD发病后7个月，双膝关节均发生了肺炎球菌性关节炎。另一名患者是一名10岁女孩，因慢性GVHD接受了多药免疫抑制治疗。BMT后51个月，她的左膝关节发生了肺炎球菌性关节炎。两名患者的皮肤慢性GVHD均延迟了关节炎的恢复。就BMT后患者的表现状态而言，这种并发症非常罕见，但可能非常严重。尽管应向高危患者接种肺炎球菌疫苗或预防性使用抗生素，但早期诊断和治疗可能是肺炎球菌性关节炎的最佳策略。
