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Case Report: Refractory Cryptosporidiosis after CAR T-Cell Therapy for Lymphoma

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  • 1 Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
  • | 2 Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
  • | 3 Division of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
  • | 4 Department of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
  • | 5 Division of Hematology and Hematologic Malignancies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

ABSTRACT.

Cryptosporidial diarrhea is uncommon in immunocompetent individuals, more often seen in severely immunocompromised patients. Severe refractory cases have been described in patients with HIV/AIDS before the advent of modern antiretroviral therapy due to an inability to mount an adequate cellular immune response. We describe an 85-year-old patient post–chimeric antigen receptor T-cell therapy relapsed lymphoma who developed refractory Cryptosporidium spp. diarrhea in the setting of persistent CD4+ cytopenia. Despite receiving multiple antiparasitic agents, including failure of a prolonged course of nitazoxanide, the patient experienced persistent symptoms for 9 months with repeatedly positivity stool Cryptosporidium spp. direct fluorescent antibody (DFA) test. We highlight this case of refractory Cryptosporidium spp. and the importance of recognizing the pathogen in a non–HIV-infected immunosuppressed host.

Author Notes

Address correspondence to Carolyn D. Alonso, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite GB, Boston, MA 02215. E-mail: calonso@bidmc.harvard.edu

Authors’ addresses: Caitlin Trottier, Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: catrotti@bidmc.harvard.edu. Christina F. Yen, Infection Control, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: cyen@bidmc.harvard.edu. Grace Malvar, Pathology, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: gmalvar@bidmc.harvard.edu. David E. Avigan, Hematology and Hematologic Malignancies, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: davigan@bidmc.harvard.edu. Jon Arnason, Beth Israel Deaconess Medical Center, Oncology, Boston, MA, E-mail: jarnason@bidmc.harvard.edu. Carolyn D. Alonso, Beth Israel Deaconess Medical Center, Infectious Diseases, Boston, MA, E-mail: calonso@bidmc.harvard.edu.

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