Large vessel vasculitis developed early after allogeneic bone marrow transplant for acute erythroid leukemia

Vasculitis is a well-known manifestation in patients with hematologic malignancies, and large vessel vasculitis (LVV) may also occur [1–3]. LVV derived from immunologic dysfunctions can be improved by autologous or allogeneic hematopoietic stem cell transplant (allo-HSCT) [4–6]. Although a patient who developed LVV during the course of chronic graft-versus-host disease (GVHD) after allo-HSCT for chronic myelogenous leukemia was previously reported [7], LVV-like symptoms developing early after allo-HSCT have not been described. We experienced a patient who developed LVV within a month of allogeneic HSCT, possibly as an immunologic reaction related to HSCT. A 61-year-old male was admitted to another hospital because of fatigue, weight loss and skin rashes in March 2012. Hematologic examination showed a white cell count of 2.69  10 9 /L, a hemoglobin concentration of 8.1 g/dL and a platelet count of 102  10 9 /L. By bone marrow aspiration, erythroid hyperplasia and trilineage dysplastic features were recognized. The percentages of erythroid precursors and blasts in the non-erythroid component in the bone marrow were 87% and 48%, respectively. The karyotype was 46,XY and the patient was diagnosed with acute erythroid leukemia. He received two courses of azacitidine therapy and was transferred to our hospital for allo-HSCT in incomplete remission. The preparative regimen consisted of fludarabine 30 mg/m 2 once daily i.v. for 6 consecutive days and busulfan 3.2 mg/kg/day divided by four times i.v. for 4 days. He underwent allogeneic bone marrow transplant from a human leukocyte antigen-matched brother in June 2012. Cyclosporine A and short-term methotrexate were used for the prophylaxis of acute GVHD. Neutrophil engraftment was observed on day 13. From day 16, he developed fever and suffered from pain in the left temple and both sides of the neck. The sites of the neck pain were found on physical examination to be restricted to the common carotid arteries. C-reactive protein was elevated to 21.27 mg/dL. Magnetic resonance imaging (MRI) on day 21 and computed tomography (CT) on day 23 demonstrated thickened walls of the large vessels from the Figure 1. (a) Magnetic resonance imaging in short-TI-inversion recovery sequence on day 21 after allogeneic bone marrow transplant (BMT) showed thickened walls of the bilateral common carotid arteries, notably on the left (arrow). (b) Contrast-enhancement CT performed on day 23 after allogeneic BMT revealed a thickened wall with delayed contrast enhancement of the aortic arch (arrowheads). aortic arch to the bilateral common carotid arteries, with delayed contrast enhancements (Figure 1). The lumens of the arteries were not narrowed. Other large arteries, including the