• Shengling Ma, Han Yan, Wei Shi, Yong You, Zhao-Dong Zhong, and Yu Hu.
• Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science And Technology, Wuhan, China.
• Medicine (Baltimore). 2020 Aug 14; 99 (33): e21752.

RationaleAs the major complications post allogeneic hematopoietic stem cell transplantation (allo-HSCT), gastrointestinal disorders were most commonly ascribed to acute graft-versus-host disease (aGVHD) and opportunistic infections. Though Giardia lamblia (G lamblia) is the most common waterborne parasite of intestinal infection worldwide, seldom has it been reported in a patient with acute severe aplastic anemia after allo-HSCT.Patient ConcernsA 23-year-old male with severe aplastic anemia developed diarrhea, abdominal cramps, bloating, nausea, vomiting, fever, weight loss, and fatigue after allo-HSCT.DiagnosisStool examinations for ova and parasites showed Giardia trophozoites and cysts.InterventionsMethylprednisolone was stopped and the patient was intravenously treated with a 7-day course of metronidazole (500 mg, tid.). Simultaneously, cyclosporine (5 mg/kg) was continually utilized for suspicious gut GVHD.OutcomesThe Giardia lamblia in stool turned negative and his symptoms were resolved after the 7-day course.LessonsIncorporating non-invasive monitoring of stool examination for ova and parasites in the follow-up algorithm for post-HSCT patients can expedite clinical decision-making in the differential diagnoses for aGVHD even in the non-endemic area. Metronidazole therapy can be well-tolerated in HSCT patients with giardiasis.

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