Pneumococcal arthritis affects performance status in patients with chronicGVHD of the skin following allogeneic bone marrow transplantation

We encountered 2 patients with pneumococcal arthritis following bone marrow transplantation (BMT). Both patients received grafts from unrelated human lymphocyte antigen(HLA)-matched donors and had suffered from chronic graft- versus-host disease (GVHD). One, a 10-year-old boy, suffered from Epstein-B arr virus-related lymphoproliferative disease (EB-LPD) and received oral 6- mercaptopurine and methotrexate to manage lymphadenopathy. Twenty-four mont hs after BMT and 7 months after the onset of EB-LPD, pneumococcal arthritis occurred in both knee joints. The other patient, a 10-year-old girl, recei ved multiagent immunosuppressive therapy for her chronic GVHD. At 51 months following BMT, pneumococcal arthritis occurred in her left knee joint. Chr onic GVHD of the skin delayed the recovery from the arthritis in both patie nts. This complication is quite rare but can be very serious, in regard to the patient's performance status following BMT. Although vaccination agains t pneumococcus or preventive antibiotics should be administered to high-ris k patients, early diagnosis and treatment may be the best strategy for pneu mococcal arthritis. (C) 2001 The Japanese Society of Hematology.