[Effective infliximab treatment for a recurrent type of acute intestinal graft-versus-host disease accompanied by steroid-induced depression]

Rinsho Ketsueki. 2012 Mar;53(3):361-6.
[Article in Japanese]

Abstract

A 22-year-old man with chronic active Epstein-Barr virus infection underwent allogeneic bone marrow transplantation (allo-BMT) from an HLA two allele-mismatched unrelated donor. Ten months after allo-BMT, he developed protein-losing enteropathy following a respiratory syncytial virus infection. A diagnosis of a recurrent type of acute graft-versus-host disease (GVHD) was made based on the histopathological findings, such as the infiltration of T lymphocytes into the superficial epithelium and crypts, and apoptotic bodies in crypts. Although methylprednisolone (mPSL: 10 mg/kg) administration for two consecutive days improved gastrointestinal symptoms, acute pancreatitis and severe depression developed in association with corticosteroid treatment. Reduction of mPSL and administration of infliximab (5 mg/kg/dose, 3 times) resulted in rapid improvement of depression and pancreatitis without aggravating intestinal GVHD. Recent studies have demonstrated that tumor-necrosis-factor (TNF)-α is associated with not only GVHD but also depression and acute pancreatitis. In the present case, anti-TNF-α treatment enabled us to reduce corticosteroid dose without aggravating GVHD, which suggests that this approach might be effective for the treatment of depression and acute pancreatitis.

Publication types

  • English Abstract

MeSH terms

  • Acute Disease
  • Antibodies, Monoclonal / therapeutic use*
  • Bone Marrow Transplantation
  • Depression / chemically induced*
  • Depression / drug therapy*
  • Epstein-Barr Virus Infections / therapy
  • Gastrointestinal Diseases / drug therapy*
  • Gastrointestinal Diseases / etiology
  • Graft vs Host Disease / drug therapy*
  • Graft vs Host Disease / etiology
  • Humans
  • Infliximab
  • Male
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / adverse effects*
  • Molecular Targeted Therapy*
  • Pancreatitis / drug therapy
  • Pancreatitis / etiology
  • Recurrence
  • Transplantation, Homologous
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha*
  • Young Adult

Substances

  • Antibodies, Monoclonal
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Methylprednisolone