Chronic graft-versus-host disease-related polymyositis and myocarditis: A case report and review of the literature.

Chronic graft-versus-host disease (cGVHD) is a major late complication of hematopoietic stem cell transplantation (HSCT). Polymyositis (PM) has been reported to be an uncommon presentation of cGVHD. Myocarditis is an even rarer manifestation of cGVHD-associated PM. Here, we report a 38-year-old male patient developed cGVHD-related PM twelve years post-transplantation, which was confirmed by muscle biopsy and immunological study. The presence of pain in the chest area, dynamic changes in the electrocardiogram, as well as elevated troponin and myocardial enzyme levels with improvement after immunotherapy all pointed to cardiac involvement. Ruxolitinib in combination with tachlimus and methylprednisolone successfully treated cGVHD associated PM with myocarditis. The literature on cGVHD-related PM and myocarditis is briefly reviewed.

Tandem fecal microbiota transplantation cycles in an allogeneic hematopoietic stem cell transplant recipient targeting carbapenem-resistant Enterobacteriaceae colonization: a case report and literature review.

BACKGROUND: Due to limited antibiotic options, carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with high non-relapse mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Also, intestinal CRE colonization is a risk factor for subsequent CRE infection. Several clinical studies have reported successful fecal microbiota transplantation (FMT) for the gut decontamination of a variety of multidrug-resistant bacteria (MDRB), even in immunosuppressed patients. Similarly, other studies have also indicated that multiple FMTs may increase or lead to successful therapeutic outcomes. CASE PRESENTATION: We report CRE colonization in an allo-HSCT patient with recurrent CRE infections, and its successful eradication using tandem FMT cycles at 488 days after allo-HSCT. We also performed a comprehensive microbiota analysis. No acute or delayed adverse events (AEs) were observed. The patient remained clinically stable with CRE-negative stool culture at 26-month follow-up. Our analyses also showed some gut microbiota reconstruction. We also reviewed the current literature on decolonization strategies for CRE. CONCLUSIONS: CRE colonization led to a high no-relapse mortality after allo-HSCT; however, well-established decolonization strategies are currently lacking. The successful decolonization of this patient suggests that multiple FMT cycles may be potential options for CRE decolonization.