Polyclonal lymphocytic infiltrate with arachnoiditis resulting from intrathecal stem cell transplantation

Abstract

Stem cell treatment outside of studied and approved medical indications can have unforeseen adverse consequences. Here, we present a 74-year-old male that underwent such therapy. The patient presented to our institution with progressive lower extremity weakness and urinary incontinence. He had previously undergone intrathecal stem cell therapy in Moscow, Russia for weakness and fatigue. Magnetic resonance imaging of his thoracic and lumbar spine showed marked enlargement of the cauda equina nerve roots and abnormal mass-like soft tissue involving the thoracolumbar thecal sac. Surgical biopsy of the intrathecal soft tissue showed polyclonal lymphocytic and glial cell proliferation. The patient’s symptoms did not improve with medical treatment or radiation, and he is currently under observation after multidisciplinary evaluation. Our patient’s experience illustrates one of the potential risks of “stem cell tourism” and exemplifies the imaging and histopathologic features of this rare entity. We also compare our patient’s treatment with other similar examples of stem cell treatments in our institution and others. These have had a wide spectrum of results. In some instances, intrathecal stem cells have caused abnormal imaging findings without any associated patient symptoms. In extreme examples, however, stem cell treatments have resulted in central nervous system neoplasms. Our patient’s lesion is quite unique, with only one similar lesion having been previously published.