Cerebral large artery occlusion in chronic graft-versus-host disease: A case report. Issue 51 (23rd December 2021)

• Record Type: Journal Article
• Authors: Li, Ying; Gao, Feng; Sun, Wei; Wang, Zhaoxia; Jin, Haiqiang
• Editors: Saranathan., Maya
• Is Part Of: Medicine. Volume 100:Issue 51(2021)
• Page Start: e28263
• Publication Date: 2021-12-23
• Subjects: central nervous system -- graft-versus-host disease -- large vessel occlusion -- vasculitis; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000028263
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Cerebral large artery occlusion in chronic central nervous system graft-versus-host disease after allogeneic hematopoietic stem cell transplantation (allo-HSCT) was very scarce. We described a young patient with bilateral white matter lesions and symptomatic internal carotid artery occlusion after allo-HSCT with the history of aplastic anemia. Patient concerns: A 17-year-old girl with the history of aplastic anemia developed recurrent headache and sudden hemiplegia of right limbs 2 years after allo-HSCT. Diagnoses: She was diagnosed with skin chronic graft-versus-host disease 19 months after allo-HSCT. Brain magnetic resonance imaging showed bilateral subcortical white matter abnormal signals and hyperintensity of left fronto-parietal lobe on diffusion weighted imaging and corresponding hypointense apparent diffusion coefficients indicating acute infarction. CT angiography revealed thrombosis in left internal carotid artery. Carotid plaque high-resolution magnetic resonance imaging showed annular enhancement of vascular wall revealing signs of vasculitis. Interventions: Intravenous immunoglobulin, methylprednisolone, and anticoagulant therapy were used to treat the patient. Outcomes: The patient's symptoms gradually resolved and she could walk with assistance after 3 weeks before returned home. Lessons: Chronic graft-versus-host disease-associated vasculitis could involve cerebral large vessels which warrants further study.