[CIS PIDD] [cis-pidd] Psychiatric Illness after Bone Marrow Transplant

[CIS-PIDD]

Dear Colleagues:

I would like to know if anyone has had patient problems with psychiatric illness outside the immediate recovery period following BMT?  I have an 18 year old male patient with X-linked SCIDS transplanted during infancy with incomplete B-cell engraftment and CD4 count typically in the 150-200 range who has had a steady decline in health over the past 5 or 6 years.  He had problems in school early on, and underwent several evaluations yielding diagnoses of  OCD, ODD, ADHD, Borderline Personality Disorder, Panic Disorder and possibly a Narcissistic Personality Disorder.  He has been frankly psychotic over the past 12 months, engaged in self-harming activities, regularly runs away from home and has been arrested and suffered sexual assault while in a shelter.   

No fevers, and no other changes in status noted.  Infectious disease history fairly unremarkable except for occasional otitis and sinusitis.  He has Raynaud’s type changes of the extremities in the cold.  Recent MRI was normal.  I asked for Neurology consultation and suggested a lumbar puncture during recent commitment, but this was not done. 

He received conditioning prior to transplant, but I don’t have a history of specifics.  He took CsA for one year afterwards, but this was a fairly unremarkable period for him.  

Family history- both parents street people with polysubstance abuse histories and personality disorders.  His mother was found unresponsive in the snow at 5 months gestation with needle in her arm— she a known carrier of X-linked SCIDS.  His adoptive family has met the transplant donor, unfortunately also recently a street person with psychological struggles and a substance abuse background.

Does anyone have ideas on further evaluation of this young man? 

Thank you,

Michael H. Clayton, MD, MPH
Assistant Professor, UNM Peds ID / Immunology
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