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albendazole was withdrawn on the 7th d of treatment.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.
CONFLICT OF INTEREST: None declared.