Muhammad Nazir, age 24 years and a resident of Lakii Marwat was diagnosed as a case of severe Aplastic Anaemia in July 2012. The work-up of the patient showed PNH clone of 18% and during the span of one and half year he received around 25 units of red cells transfusions and more than 100 units of platelets transfusions. Due to his severe disease he was recommended allogenic stem cell transplant. luckily he had matched sibling donor (brother) and he undergone bone marrow transplant on 10th January 2014. Nazir had an engraftment on day +13 but on day +16 developed pleural effusion on right side of the chest. on day +24 post BMT, his chest intubation was done by thoracic surgeon and was put on anti tuberculosis therapy. on day +40 his pleural effusion progressed and his surgical decortications of the right side of the chest was done. During the recovery period of his surgical treatment he developed haemorrhagic cystitis and micro angiopathic haemolytic anaemia. These complications are superadded by CMV infection of the lungs, which was reported on HRCT chest and confirmed on CMV by PCR test.
At this stage, we almost lost the hope of recovery but every doctor of our institute took this case as a challenge and addressed each complication in a professional way. His haemorrhagic cystitis settled in about 25 days time by continuous bladder irrigation of about 10-12 liter/day. micro angiopathic haemolytic anaemia settled after stopping cyclopsorin therapy and replaced by second line immunosuppressive drugs. CMV infection was actively managed with Gancilovir (5mg/kg BW x 12 hourly) for three weeks. His pleural effusion regressed with passage of time and his anti tuberculin therapy continued.
Now he is six months post BMT and recovered from pleural effusion, CMV infection, hemorrhagic cystitis and micro angiothic haemolytic anaemia. Yesterday he came in OPD with smiling face and looks quite healthy. His shining eyes were dictating his hope of second life.