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Milton Artur Ruiz,1 Roberto Luiz Kaiser Junior,2 Luiz Gustavo de Quadros,2 Gustavo Henrique Xavier Caseiro,2 Aderson Francisco Oliveira,1 Tatiana Peña-Arciniegas,1 Lilian Piron-Ruiz,1 Fernanda Soubhia Liedtke Kaiser,2 Vera Lucia Oliveira2 1Bone Marrow Transplant Department, Associação Portuguesa de Beneficencia de São José do Rio Preto, 2Kaiser Clinica, Centro Médico Avançado de São José do Rio Preto, Sao Paulo, Brazil Background: Hematopoietic stem cell transplantation (HSCT) can be used in the treatment of patients with refractory Crohn’s disease (CD) when no alternative treatment is available. However, HSCT increases the risk of infections, in particular during the aplasia of mobilization and conditioning. Moreover, intestinal stomas in CD augment the risk of morbidity in immunocompromised patients and under aplastic conditions. The objective of this report was to describe the results of the first year after HSCT in a CD patient with an intestinal stoma. Methods: The patient was assessed in respect to disease symptoms and endoscopic findings before the procedure and 30, 90, 180, and 365 days after HSCT.Results: No complications were observed during mobilization and conditioning with sufficient CD34+ cells being harvested in just one apheresis session. Toxicity was restricted to the hematological series. Scores of all the CD indexes and the quality of life of the patient improved. However, two of three endoscopic scores remained unchanged even though improvements were found in the appearance of the lesions.Conclusion: HSCT may be an alternative treatment for refractory CD in patients with an intestinal stoma, and a priori, carefully selected patients with stomas should not be excluded as candidates for this procedure. Keywords: Crohn’s disease, intestinal stoma, hematopoietic stem cell transplant, stem cell therapy, autologous HSCT, autoimmune diseases, nonmyeloablative HSCT

[english] Objective: To report on a case of retinal pigment epithelium (RPE) toxicity apparently associated with ritonavir.Methods: We describe a case of gradual-onset blurry vision in both eyes in a 30-year-old HIV-positive male on Highly-Active Antiretroviral Therapy (HAART) including ritonavirResults: The patient presented with a visual acuity of 3/10 in each eye, and fundoscopy revealed paracentral pigment mottling. Computerized perimetry showed a ring-scotoma in both eyes. Fluorescein angiography revealed an anular RPE defect in both eyes, congruent with hyperautofluorescent changes on autofluorescence imaging. Full-field ERG was normal. Conclusions: Since ritonavir has previously been linked with toxicity to the RPE, we consider this report as further evidence of this association.[german] Zielsetzung: Bericht über einen möglichen Zusammenhang zwischen der Toxizität des Retinalen Pigmetepithels (RPE) und Ritonavir.Methoden: Wir beschreiben einen Fall schrittweise einsetzender Sehstörungen beider Augen eines 30-jährigen HIV-positiven Mannes auf Highly-Active Antiretroviral Therapie (HAART).Ergebnisse: Der Patient hatte eine Sehschärfe von 3/10 in jedem Auge und eine Funduskopie zeigte eine parazentrale Pigment-Marmorierung. Eine Computerperimetrie offenbarte ein Ringskotom in beiden Augen. Eine Fluoreszenzangiographie zeigte einen ringförmigen RPE-Defekt in beiden Augen, deckungsgleich mit hyperautofluoreszenten Veränderungen im Autofluoreszenz-Imaging. Das Ganzfeld-ERG war normal.Schlussfolgerungen: Da Ritonavir bereits mit der RPE-Toxizität in Verbindung gebracht wurde, betrachten wir diesen Bericht als weiteren Beweis dieses Zusammenhangs.