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A patient with chronic myelogenous leukemia developed chronic graft-versus-host disease (GVHD) after bone marrow transplantation (BMT) and subsequently developed neuromyotonia (NMT). Such a manifestation of GVHD has never been observed previously.
Case report.
A 29-year-old man with chronic myelogenous leukemia Ph1+ received a BMT from his human leukocyte antigen-compatible brother in May 1996. He was given interferon alpha 2a (9 MU/day) and hydroxyurea (3 g/day) before BMT. The patient started treatment with cyclosporine A (250 mg/day) as prophylaxis against GVHD, and acyclovir (3.2 g/day). One month later, while tapering cyclosporine A (150 mg/day), a chronic GVHD involving the lacrimal glands and the skin developed. The patient also had muscle soreness, diffuse stiffness, and cramps particularly involving hand and facial muscles. Because of the stiffness, he had serious difficulty in rising from a chair or bed and in chewing and yawning. There was symmetrically increased tone and continuous muscle contraction of the upper and lower extremities, more pronounced distally, and delayed relaxation. Cramps were exacerbated by voluntary and passive movements. Simultaneous …
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