A case of hyposplenism with recurrent invasive pneumococcal disease following haploidentical HSCT

Abstract

We report the case of 5-year-old boy with BCP ALL who had very early bone marrow relapse. He received an allogeneic HSCT from his HLA haploidentical mother in his second remission. Although he had developed acute and chronic GVHD, he was free from all immunosuppressive agents 18 months after the HSCT. Then, he contracted his first IPD 26 months after the HSCT, and he contracted it again (serotype of 15A) 7 months after the first one. Because Howell Jolly bodies were detected in his peripheral blood before the first IPD, technetium 99m-labelled tin colloidal scintiscan was conducted, which revealed a perfusion defect of his spleen. Sequential CT images taken after the HSCT showed that his spleen was gradually shrinking, which resulted in atrophy before the first IPD. Trimethoprim/sulfamethoxazole given after the second IPD resulted in no recurrence of IPD.