Yıl: 2013 Cilt: 30 Sayı: 2 Sayfa Aralığı: 204 - 208 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity

Öz:
Önceden akut myelomonositik lösemi(M4) tanısı almış 50 yaşındaki erkek hastaya, Temmuz 2009’da allojenik hematopoietik kök hücre nakli yapıldı (AHKHN). Nakil öncesi dönemde, tam kan sayımı, karaciğer ve böbrek fonksiyon testleri, koagulasyon parametreleri ve diğer ölçümler normal bulundu. Naklin birinci gününde,orofaringeal candidiasisle birlikte ağız içindeki beyaz plaklar ve ayrıca perianal eritem nedeniyle hastaya intravenöz teikoplanin (ilk 3 gün 400mg/ gün ve sonrasında günde 400mg) ve kaspofungin (ilk doz 1x70 mg/gün ve sonrasında 1x50 mg/gün) başlandı. Naklin 14.gününde,karında huzursuzluk, bulantı ve yorgunluk gibi şikayetlerle birlikte sulu diare ortaya çıktı. gaita incelemesinde kanama bulgusu yoktu. Tür-özgün IFA metodu ile nadir bir patojen olan Encephalitozoon intestinalis tesbiti doğrulandı ve 2x400 mg/gün albendazol tedavisi hemen başlandı. Albendazol tedavisinin 5. gününde (naklin 18. günü), hastanın karaciğer fonksiyon testleri (KCFT) bozulmaya başladı. KCFT’nin bozulması devam ettiğinden, tedavinin 7. gününde albendazol kesildi. Naklin 22. gününde Kc biopsisi yapılarak, tanı patologlar tarafından ‘toxik hepatit’ olarak doğrulandı. KCFT albendazol tedavisinin kesilmesinden sonra hızla düzelmeye başladı. albendazol tedavi sürecinin 13.gününde tüm KCFT değerleri normale döndü. Bu vaka; AHKHN yapılmış bir hastada nadir diare etkeni - Encephalitozoon intestinalis- ile albendazol tedavisi sırasında gelişen hepatotoksisiteyi göstermektedir. Ayrıca, IFA metodu ile Türkiye’den bildirilen ilk E. intestinalis vakasıdır.
Anahtar Kelime:

Konular: Hematoloji

Allojenik hematopoietik kök hücre nakli alıcısında albendazol tedavisi sırasında gelişen hepatotoksisite ile komplike olmuş nadir bir diare etkeni: Encephalitozoon intestinalis

Öz:
A 50-year-old male patient previously diagnosed with acute myelomonocytic (M4) leukemia in July 2009 underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). During the pre-transplant period complete blood count (CBC), liver and renal function tests, coagulation tests, and other parameters were normal. On the first day of transplantation teicoplanin (400 mg d–1 for the first 3 d, and then 400 mg d-1) and caspofungin (first dose was 1×70 mg d–1, followed by 1×50 mg d–1) were started intravenously due to white plaques and oropharyngeal candidiasis in the patient’s mouth and perianal erythema. On the 14th d of transplantation watery diarrhea occurred, along with abdominal discomfort, nausea, and fatigue. Stool examination was negative for findings of bleeding. Investigation of Microsporidia confirmed a rare pathogen Encephalitozoon intestinalis in the patient’s stool sample via species-specific immunofluorescence antibody (IFA) assay and albendazole treatment was started at a dose of 2×400 mg d–1. On the 5th d of albendazole treatment (d 18 of treatment) liver function test (LFT) results began to deteriorate. As LFT results continued to deteriorate, albendazole was withdrawn on the 7th d of treatment. Biopsy was performed on the 22nd d of transplantation and histopathological analysis confirmed the diagnosis of toxic hepatitis. LFT results began to decrease after withdrawal of albendazole treatment. On the 13th d of albendazole treatment all LFT values returned to normal. The presented allo-HSCT case had a rare pathogenic agent (E. intestinalis) that caused diarrhea, as well as hepatotoxicity due to albendazole treatment. This is the first reported case of E. intestinalis diagnosed via IFA in Turkey.
Anahtar Kelime:

Konular: Hematoloji
Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık
  • 1. van Kraaij MG, Dekker AW, Verdonck LF van Loon AM, Vinjé J, Koopmans MP, Rozenberg-Arska M. Infectious gastro-enteritis: an uncommon cause of diarrhoea in adult allogeneic and autologous stem cell transplant recipients. Bone Marrow Transplant 2000;26:299-303.
  • 2. Yolken RH, Bishop CA, Townsend TR, Bolyard EA, Bartlett J, Santos GW, Saral R. Infectious gastroenteritis in bone-marrow-transplant recipients. New Engl J Med 1982;306:1010-1012.
  • 3. Bilgrami S, Feingold JM, Dorsky D, Edwards RL, Bona RD, Khan AM, Rodriguez-Pinero F Clive J, Tutschka PJ. Incidence and outcome of Clostridium difficile infection following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1999;23:1039-1042.
  • 4. Lanternier F Boutboul D, Menotti J, Chandesris MO, Sarfati C, Mamzer Bruneel MF Calmus Y, Mechaï F Viard JP, Lecuit M, Bougnoux ME, Lortholary O. Microsporidiosis in solid organ transplant recipients: two Enterocytozoon bieneusi cases and review. Transpl Infect Dis 2009;11:83-88.
  • 5. Barbosa J, Rodrigues AG, Pina-Vaz C. Cytometric approach for detection of Encephalitozoon intestinalis, an emergent agent. Clin Vaccine Immunol 2009;16):1021-1024.
  • 6. Wolk DM, Schneider SK, Wengenack NL, Sloan LM, Rosenblatt JE. Real-time PCR method for detection of Encephalitozoon intestinalis from stool specimens. J Clin Microbiol 2002;40:3922-3928.
  • 7. Guerard A, Rabodonirina M, Cotte L, Liguory O, Piens MA, Daoud S, Picot S, Touraine JL. Intestinal microsporidiosis occurring in two renal transplant recipients treated with mycophenolate mofetil. Transplantation 1999;68:699-707.
  • 8. Thellier M, Breton J. Enterocytozoon bieneusi in human and animals, focus on laboratory identification and molecular epidemiology. Parasite 2008;15:349-358.
  • 9. Alfa Cisse O, Ouattara A, Thellier M, Accoceberry I, Biligui S, Minta D, Doumbo O, Desportes-Livage I, Thera MA, Danis M, Datry A. Evaluation of an Immunofluorescent-Antibody Test Using Monoclonal Antibodies Directed against Enterocytozoon bieneusi and Encephalitozoon intestinalis for Diagnosis of Intestinal Microsporidiosis in Bamako (Mali). J Clin Microbiol 2002;40:1715-1718.
  • 10. Kim BK, Chung KW, Sun HS, Suh JG, Min WS, Kang CS, Sim SI, Shin WS, Kim CC. Liver disease during the first post- transplant year in bone marrow transplantation recipients: retrospective study. Bone Marrow Transplantation 2000;26;193-197.
  • 11. El-Sayed MH, El-Haddad A, Fahmy OA, Salama II, Mahmoud HK. Liver disease is a major cause of mortality following allogeneic bone-marrow transplantation. Eur J Gastroenterol Hepatol 2004;16:1347-1354.
  • 12. Aksoy DY, Tanriover MD, Uzun O, Zarakolu P, Ercis S, Ergüven S, Oto A, Kerimoglu U, Hayran M, Abbasoglu O. Diarrhea in neutropenic patients: a prospective cohort study with emphasis on neutropenic enterocolitis. Ann Oncol 2007;18:183-189.
  • 13. Wichro E, Hoelzl D, Krause R, Bertha G, Reinthaler F Wenisch C. Microsporidiosis in travel-associated chronic diarrhea in immune-competent patients. Am J Trop Med Hyg 2005;73:285-287.
  • 14. Stine SW, Vladich FD, Pepper IL, Gerba CP. Development of a method for the concentration and recovery of microsporidia from tap water. J Environ Sci Health A Tox Hazard Subst Environ Eng 2005;40:913-925.
  • 15. Cali A, Kotler DP, Orenstein JM. Septata intestinalis N. G., N. Sp., an intestinal microsporidian associated with chronic diarrhea and dissemination in AIDS patients. Microbiol 1993;40:101-112.
  • 16. Weber R, Bryan RT, Schwartz DA, Owen RL. Human microsporidial infections. Clin Microbiol Rev 1994;7:426- 461.
  • 17. Orenstein JM, Tenner M, Cali A, Kotler DP. A microsporidian previously undescribed in humans, infecting enterocytes and macrophages, and associated with diarrhea in an acquired immunodeficiency syndrome patient. Hum Pathol 1992;23:722-728.
  • 18. Molina JM, Oksenhendler E, Beauvais B, Sarfati C, Jaccard A, Derouin F Modaï J. Disseminated microsporidiosis due to Septata intestinalis in patients with AIDS: clinical features and response to albendazole therapy. J Infect Dis 1995;171:245-249.
  • 19. Orenstein JM, Dieterich DT, Lew EA, Kotler DP. Albendazole as a treatment for intestinal and disseminated microsporidiosis due to Septata intestinalis in AIDS patients: a report of four patients. AIDS 7 1993;(Suppl 3):40-42.
  • 20. Weber R, Sauer B, Spycher MA, Deplazes P, Keller R, Ammann R, Briner J, Lüthy R. Detection of Septata intestinalis in stool specimens and coprodiagnostic monitoring of successful treatment with albendazole. Clin Infect Dis 1994;19:342-345.
APA ŞIVGIN S, Eser B, Kaynar L, KURNAZ F, ŞIVGIN H, YAZAR S, ÇETİN M, ÜNAL A (2013). Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. , 204 - 208.
Chicago ŞIVGIN Serdar,Eser Bülent,Kaynar Leylagul,KURNAZ Fatih,ŞIVGIN Hülya,YAZAR Süleyman,ÇETİN Mustafa,ÜNAL Ali Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. (2013): 204 - 208.
MLA ŞIVGIN Serdar,Eser Bülent,Kaynar Leylagul,KURNAZ Fatih,ŞIVGIN Hülya,YAZAR Süleyman,ÇETİN Mustafa,ÜNAL Ali Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. , 2013, ss.204 - 208.
AMA ŞIVGIN S,Eser B,Kaynar L,KURNAZ F,ŞIVGIN H,YAZAR S,ÇETİN M,ÜNAL A Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. . 2013; 204 - 208.
Vancouver ŞIVGIN S,Eser B,Kaynar L,KURNAZ F,ŞIVGIN H,YAZAR S,ÇETİN M,ÜNAL A Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. . 2013; 204 - 208.
IEEE ŞIVGIN S,Eser B,Kaynar L,KURNAZ F,ŞIVGIN H,YAZAR S,ÇETİN M,ÜNAL A "Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity." , ss.204 - 208, 2013.
ISNAD ŞIVGIN, Serdar vd. "Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity". (2013), 204-208.
APA ŞIVGIN S, Eser B, Kaynar L, KURNAZ F, ŞIVGIN H, YAZAR S, ÇETİN M, ÜNAL A (2013). Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. Turkish Journal of Hematology, 30(2), 204 - 208.
Chicago ŞIVGIN Serdar,Eser Bülent,Kaynar Leylagul,KURNAZ Fatih,ŞIVGIN Hülya,YAZAR Süleyman,ÇETİN Mustafa,ÜNAL Ali Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. Turkish Journal of Hematology 30, no.2 (2013): 204 - 208.
MLA ŞIVGIN Serdar,Eser Bülent,Kaynar Leylagul,KURNAZ Fatih,ŞIVGIN Hülya,YAZAR Süleyman,ÇETİN Mustafa,ÜNAL Ali Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. Turkish Journal of Hematology, vol.30, no.2, 2013, ss.204 - 208.
AMA ŞIVGIN S,Eser B,Kaynar L,KURNAZ F,ŞIVGIN H,YAZAR S,ÇETİN M,ÜNAL A Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. Turkish Journal of Hematology. 2013; 30(2): 204 - 208.
Vancouver ŞIVGIN S,Eser B,Kaynar L,KURNAZ F,ŞIVGIN H,YAZAR S,ÇETİN M,ÜNAL A Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity. Turkish Journal of Hematology. 2013; 30(2): 204 - 208.
IEEE ŞIVGIN S,Eser B,Kaynar L,KURNAZ F,ŞIVGIN H,YAZAR S,ÇETİN M,ÜNAL A "Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity." Turkish Journal of Hematology, 30, ss.204 - 208, 2013.
ISNAD ŞIVGIN, Serdar vd. "Encephalitozoon intestinalis: A rare cause of diarrhea in an allogeneic hematopoietic stem cell transplantation (HSCT) recipient complicated by albendazole-related hepatotoxicity". Turkish Journal of Hematology 30/2 (2013), 204-208.