Tuberculosis infection after allogeneic hematopoietic stem cell transplantation: An analysis of clinical characteristics / 第二军医大学学报

ABSTRACT

Objective To analyze the clinical characteristics, predisposing factors and prognosis of tuberculosis (TB) patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and to summarize the clinical treatment experience. Methods The information of 7 confirmed TB patients after allo-HSCT, including the onset time, symptoms, laboratory findings, imaging findings, treatment and prognosis, was collected, and their clinical characteristics and regulations were summarized. Results Seven of the 481 patients who received allo-HSCT were found to have TB, with an post-transplantation TB incidence rate of 1. 46%. The seven patients included 2 females and 5 males, ranging 18-46 years and averaging (31.3 ± 9. 6) years old. Five patients had pulmonary tuberculosis (2 with hematogenous disseminated pulmonary tuberculosis), 1 had tuberculous pleurisy, 2 had tuberculous meningitis, and 1 had bladder tuberculosis. The clinical manifestations included fever, cough, urinary tract symptom, and headache. Three cases had history of chronic graft versus host disease(GVHD) while one of them experienced acute GVHD. PPD test and tuberculosis antibody test were negative in all the 7 patients peripheral blood T-SPOT test was positive in 3 cases, with one having positive bronchoalveolar lavage fluid smear. Biopsy results showed granulomatous inflammation in 2 cases, with 1 accompanied by coagulative necrosis. Chest CT showed patched shadow in 3 cases, miliary nodule shadows in 2 and pleural effussion in one. Six patients were clinically cured after anti-tuberculosis treatment and one died, with an effective rate of 85.7%. Conclusion TB infection should be considered once the patients receiving allo-HSCT have infectious symptoms, and early screening should be done to avoid misdiagnosis and missed diagnosis. Early diagnosis and routine anti-TB treatment can yield good outcome.