Tamura Shinichi, Ishida Hiroyuki, Shimizu Tsunehiro, Imaeda Hirotsugu, Nishida Atsushi, Bamba Shigeki, Andoh Akira, Iwasa Yoko, Kuroda Hiroshi
Department of Pediatrics, Kyoto City Hospital.
Department of Infectious Diseases, Kyoto City Hospital.
Rinsho Ketsueki. 2022;63(3):217-223. doi: 10.11406/rinketsu.63.217.
We report a case of a 15-year-old girl who developed refractory Clostridioides difficile infection (CDI) after allogeneic bone marrow transplantation (BMT). She was treated successfully with fecal microbiota transplantation (FMT). The patient who had aplastic anemia underwent allogeneic BMT from an HLA 1-locus-mismatched unrelated donor. Four months later, she developed gastrointestinal graft-versus-host disease (GVHD), and immunosuppressive treatment improved the GVHD. However, she developed CDI 5 months after BMT and experienced recurrence after that. Fifteen months after transplant, CDI relapsed despite discontinuation of immunosuppressive treatment; thus, she underwent FMT. Colonoscopy at the time of FMT revealed round aphthae, mainly in the ileocecum, and colonic biopsy revealed inflammatory cell infiltration and noncaseating epithelioid granuloma, which fulfilled the diagnostic criteria for Crohn's disease. Following FMT for CDI, she was treated with enteric budesonide and intravenous methotrexate for Crohn's disease. These interventions resulted in a marked improvement in both CDI and Crohn's disease. Twenty-eight months after FMT, both CDI and Crohn's disease remained in remission with oral mesalamine monotherapy.
我们报告一例15岁女孩，她在异基因骨髓移植（BMT）后发生了难治性艰难梭菌感染（CDI）。她通过粪便微生物群移植（FMT）成功治愈。该再生障碍性贫血患者接受了来自一名HLA 1位点不匹配的无关供者的异基因BMT。四个月后，她出现了胃肠道移植物抗宿主病（GVHD），免疫抑制治疗改善了GVHD。然而，她在BMT后5个月发生了CDI，此后经历了复发。移植后15个月，尽管停用了免疫抑制治疗，CDI仍复发；因此，她接受了FMT。FMT时的结肠镜检查显示圆形阿弗他溃疡，主要位于回盲部，结肠活检显示炎性细胞浸润和非干酪样上皮样肉芽肿，符合克罗恩病的诊断标准。在因CDI接受FMT后，她接受了肠溶布地奈德和静脉注射甲氨蝶呤治疗克罗恩病。这些干预措施使CDI和克罗恩病均有显著改善。FMT后28个月，CDI和克罗恩病均通过口服美沙拉嗪单药治疗维持缓解。
