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We report a case of fulminant Crohn's colitis that occurred following non-myeloablative allogeneic stem cell transplantation for Hodgkin's lymphoma. Adoptive transfer of inflammatory bowel disease by haematopoietic cells is recognised in several animal models of inflammatory bowel disease and remission of Crohn's disease has been reported in patients who have received a bone marrow transplant. However, adoptive transfer of Crohn's disease susceptibility leading to phenotypic manifestation of the disease after transplantation has not been previously reported. Having ruled out an infective cause of a colitis in this case, we speculated that adoptive transfer of Crohn's disease may have occurred and performed a genetic analysis of known susceptibility loci for significant donor-recipient mismatches. The donor and recipient had several haplotype mismatches in HLA class III genes at the IBD3 locus. In addition, the donor (but not the recipient) had a polymorphism of the 5' UTR of NOD2/CARD15 that may be associated with Crohn's disease. This case highlights the question of whether adoptive transfer of Crohn's disease can occur between allogeneic stem cell transplant donor and recipient, in a similar fashion to that reported for other autoimmune diseases. This report should also stimulate debate regarding the need for stem cell transplant donor screening for inflammatory bowel disease.

Type

Journal article

Journal

Gut

Publication Date

10/2003

Volume

52

Pages

1518 - 1521

Keywords

5' Untranslated Regions, Acute Disease, Adult, Carrier Proteins, Crohn Disease, Female, Genetic Predisposition to Disease, Haplotypes, Hodgkin Disease, Humans, Immunosuppressive Agents, Intracellular Signaling Peptides and Proteins, Nod2 Signaling Adaptor Protein, Polymorphism, Genetic, Stem Cell Transplantation, Transplantation Conditioning, Transplantation, Homologous