Hemophagocytic bone marrow aplasia with plasma cells in a RAG2-deficient SCID case after a nonconditioned transplantation from a fully matched sibling

J Pediatr Hematol Oncol. 2013 Nov;35(8):e335-7. doi: 10.1097/MPH.0b013e31827e8448.

Abstract

We report a RAG2-deficient patient with severe combined immunodeficiency and hemophagocytic bone marrow aplasia with plasma cells after a nonconditioned transplantation from a fully matched sibling. After engraftment, disseminated BCGosis appeared because of graft versus host disease prophylaxis. On the 55th day, eosinophilia, neutropenia, and thrombocytopenia developed. Aplasia, hemophagocytic histiocytes, and plasma cells were found on his bone marrow with very high level of serum immunoglobulin E. We could not discriminate exactly whether BCGosis or alloimmune response is the cause of hemophagocytic aplasia with plasma cells. Despite the second hematopoietic stem cell transplantation with a reduced intensity conditioning regime, his marrow aplasia did not recover and he died. This case suggests that BCGosis might be associated with hemophagocytic marrow aplasia with plasma cells in an alloimmune reaction.

Publication types

  • Case Reports

MeSH terms

  • BCG Vaccine / adverse effects*
  • BCG Vaccine / immunology
  • Bone Marrow Diseases / etiology*
  • Bone Marrow Diseases / pathology
  • DNA-Binding Proteins / genetics*
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Infant
  • Lymphohistiocytosis, Hemophagocytic / etiology*
  • Lymphohistiocytosis, Hemophagocytic / pathology
  • Male
  • Nuclear Proteins / genetics*
  • Plasma Cells / pathology
  • Severe Combined Immunodeficiency / genetics
  • Severe Combined Immunodeficiency / surgery*
  • Transplantation Conditioning
  • Transplantation, Homologous / adverse effects

Substances

  • BCG Vaccine
  • DNA-Binding Proteins
  • Nuclear Proteins
  • RAG2 protein, human