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Case Report

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

Caitlin A. Trottier Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;

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Christina F. Yen Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;

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Grace Malvar Division of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;

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Jon Arnason Department of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;

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David E. Avigan Division of Hematology and Hematologic Malignancies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

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Carolyn D. Alonso Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;

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DOI:
https://doi.org/10.4269/ajtmh.21-0246
Volume/Issue:
Volume 105: Issue 3
Page(s):
651–653
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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.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2021
Received:
27 Feb 2021
|
Accepted:
22 Mar 2021
|
Published Online:
08 Jul 2021
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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