Severe Brain Atrophy after Allogeneic Hematopoietic Stem Cell Transplantation in a Patient Suffering from Chronic Graft-versus-host Disease.
Yasutaka Masuda, Akira Honda, Reo Yoshioka et al.
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Case in brief
A 30-year-old man developed brain atrophy approximately one year after allogeneic hematopoietic stem cell transplantation for acute lymphoblastic leukemia, most prominently affecting both medial temporal lobes. He also had concurrent myositis. After other causes were excluded, the central nervous system findings were attributed to chronic graft-versus-host disease. The brain and muscle manifestations did not respond to steroid treatment and progressed while he was receiving ibrutinib.
What made this case unusual
The marked bilateral medial temporal lobe atrophy was considered a manifestation of chronic graft-versus-host disease in the setting of concurrent myositis, after other etiologies were ruled out.
Diagnostic / clinical pearl
In a patient with chronic graft-versus-host disease after transplantation, brain atrophy—particularly involving the medial temporal lobes—may accompany other organ manifestations; assess for alternative causes before attributing it to CNS involvement.
Why it matters
The report highlights the need for active surveillance and assessment of transplantation-related CNS changes.