Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.425
Peer-review started: November 8, 2019
First decision: November 19, 2019
Revised: December 2, 2019
Accepted: December 21, 2019
Article in press: December 21, 2019
Published online: January 26, 2020
Core tip: The aberrant immune responses in aplastic anemia had been proposed to be triggered by altered gut microbiota, and our serendipitous finding that a 30-year-old man with refractory severe aplastic anemia had gained an inadvertently excellent hematological response following oral administration of mannitol and gentamycin provides convincing evidence to support the hypothetical but plausible pathogenic association. Several comorbid diseases on this patient were ameliorated together with the hematological improvements, indicating commonly shared etiological associations between the comorbidities and aplastic anemia in a background consisting of altered gut microbiota, chronic intestinal inflammation, increased epithelial permeability, and an autoimmune nature, instead of the adverse events of cyclosporine and iron overload.