{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T19:50:20Z","timestamp":1767383420358,"version":"3.41.2"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,3,3]],"date-time":"2019-03-03T00:00:00Z","timestamp":1551571200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["5T32HL007574-35"],"award-info":[{"award-number":["5T32HL007574-35"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>TA\u2010TMA is a described complication of aHCT in children with neuroblastoma. Outcomes are poor with mortality rates approaching 60%. Described late effects in survivors include chronic kidney disease and persistent pulmonary hypertension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case<\/jats:title><jats:p>We report a case of a 2\u2010year\u2010old with neuroblastoma who developed severe TA\u2010TMA 35\u00a0days after high dose chemotherapy and autologous stem cell rescue. He presented with respiratory failure, pericardial and pleural effusions, hemolysis, hypertension, and mild altered mental status. He was mechanically ventilated for 3\u00a0weeks and after sedation was lifted, he was minimally responsive. He was treated with eculizumab with resolution of hemolysis, kidney injury and polyserositis. Initially he was more responsive; however, after almost a year of intensive therapy he remained nonverbal and had persistent irritability and behavioral changes. He had an extensive negative evaluation. On day +345, he presented with severe, refractory epilepsy. Three years after TA\u2010TMA, he continues to have severe neurologic disabilities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>To our knowledge, persistent neurologic toxicity has not been reported in TA\u2010TMA. However, deficits and seizures are reported in other TMAs, particularly in children with atypical HUS who present with significant neurologic changes at diagnosis. Our patient's persistent neurologic disability despite eculizumab response in all other involved organs may reflect irreversible damage. This case describes a new long\u2010term sequela of TA\u2010TMA and highlights the need for further studies to understand both acute and long\u2010term neurologic complications of this disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.13381","type":"journal-article","created":{"date-parts":[[2019,3,4]],"date-time":"2019-03-04T04:40:11Z","timestamp":1551674411000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Severe, persistent neurotoxicity after transplant\u2010associated thrombotic microangiopathy in a pediatric patient despite treatment with eculizumab"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4565-6399","authenticated-orcid":false,"given":"Michelle","family":"Schoettler","sequence":"first","affiliation":[{"name":"Dana Farber\/Boston Children\u2019s Cancer and Blood Disorders Center Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Duncan","sequence":"additional","affiliation":[{"name":"Dana Farber\/Boston Children\u2019s Cancer and Blood Disorders Center Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Dana Farber\/Boston Children\u2019s Cancer and Blood Disorders Center Boston 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