CASE REPORT

Fulminant Crohn’s colitis after allogeneic stem cell transplantation

S A Sonwalkar^1,*, R M James^2,*, T Ahmad³, L Zhang³, C S Verbeke⁴, D L Barnard², D P Jewell³, M A Hull¹

¹ Molecular Medicine Unit, University of Leeds, and Department of Gastroenterology, St James’s University Hospital, Leeds, UK
² Department of Haematology, St James’s University Hospital, Leeds, UK
³ Gastroenterology Unit, University of Oxford, Radcliffe Infirmary, Oxford, UK
⁴ Department of Histopathology, St James’s University Hospital, Leeds, UK

Correspondence to:
Correspondence to:
M A Hull, Molecular Medicine Unit, Clinical Sciences Building, St James’s University Hospital, Leeds LS9 7TF, UK;
M.A.Hull{at}leeds.ac.uk

We report a case of fulminant Crohn’s colitis that occurred following non-myeloablative allogeneic stem cell transplantation for Hodgkin’s lymphoma. Adoptive transfer of inflammatory bowel disease by haematopoietic cells is recognised in several animal models of inflammatory bowel disease and remission of Crohn’s disease has been reported in patients who have received a bone marrow transplant. However, adoptive transfer of Crohn’s disease susceptibility leading to phenotypic manifestation of the disease after transplantation has not been previously reported. Having ruled out an infective cause of a colitis in this case, we speculated that adoptive transfer of Crohn’s disease may have occurred and performed a genetic analysis of known susceptibility loci for significant donor-recipient mismatches. The donor and recipient had several haplotype mismatches in HLA class III genes at the IBD3 locus. In addition, the donor (but not the recipient) had a polymorphism of the 5' UTR of NOD2/CARD15 that may be associated with Crohn’s disease. This case highlights the question of whether adoptive transfer of Crohn’s disease can occur between allogeneic stem cell transplant donor and recipient, in a similar fashion to that reported for other autoimmune diseases. This report should also stimulate debate regarding the need for stem cell transplant donor screening for inflammatory bowel disease.

Keywords: Crohn’s disease; allogeneic stem cell transplantation; toxic megacolon

Abbreviations: CD, Crohn’s disease; ASCT, allogeneic stem cell transplantation; CT, computed tomography; GvHD, graft versus host disease; IBD, inflammatory bowel disease; CRP, C reactive protein; CMV, cytomegalovirus; HSV, herpes simplex virus; SNP, single nucleotide polymorphism

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