Ataxia Following Allogenic Stem Cell Transplantation: No Stone Unturned

Abstract

A thirty-one year-old Sri Lankan man presented with a two-month history of progressive pan-cerebellar syndrome, following allogeneic stem cell transplantation. This curative-intent therapy was performed in the context of an underlying acute myeloid leukemia. During the post-transplant period, patients are extremely vulnerable, especially due to the immunologic fluctuations. Reaching equilibrium is crucial, preventing complications of both extremes of the immunologic response, such as opportunistic infections or graft versus host disease. Numerous aetiologies were considered in the differential diagnosis of this pan-cerebellar syndrome. Most of those conditions mandate a prompt management, because of their reversible or lethal nature. Our thorough investigation process was a race against time. Excluding “Red Flags” remains the priority. Mindfulness and time will eventually lead to the proper diagnosis. We discuss our structured investigation process emphasizing on the key element: a “Systematic Approach”.