Nursing care of a patient with amyotrophic lateral sclerosis after washed microbiota transplantation: a case report

Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disorder characterized by motor neuron degeneration, and is frequently complicated by malnutrition, gastrointestinal manifestations, and gut dysbiosis. To date, no curative therapy exists for ALS, posing substantial challenges for clinical nursing practice. Washed microbiota transplantation (WMT), an advanced variant of fecal microbiota transplantation, reconstructs a healthy gut microbiota to treat intestinal and extra-intestinal disorders. However, reports on WMT for ALS and related nursing experience remain limited globally. Hence, further investigation into this therapeutic combination is warranted. A 48-year-old Chinese female patient was admitted on 22 April 2024, with a four-year history of motor impairment. Her diagnoses included amyotrophic lateral sclerosis, malnutrition, and intestinal dysbiosis. Her past medical history included myocardial bridging, hypertension, thyroid nodules, constipation, and allergies. She had undergone multiple WMT treatments previously, along with tracheostomy, ventriculoperitoneal shunt insertion, and percutaneous endoscopic gastrostomy. On admission, her muscle strength was grade 2 in both upper limbs and grade 3 in both lower limbs, with an Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) score of 40. The patient received WMT for three consecutive days (23–25 April 2024) and holistic nursing interventions for approximately one month, including donor screening, complication monitoring, percutaneous endoscopic gastrostomy tube care, respiratory management, and discharge planning. Following multimodal combined interventions, her serum prealbumin rose to 230 mg/L, indicating improved nutritional status. The ALSFRS-R score remained stable, and no decline in muscle strength was noted. Findings from this single case cannot establish a direct causal link between WMT and these clinical improvements. This case primarily reports the full-course nursing protocol for an ALS patient receiving WMT; available data from this single case are insufficient to confirm direct therapeutic benefits attributable to WMT alone. This clinical observation highlights that standardized, comprehensive nursing care is crucial for ensuring safe implementation of WMT. The findings provide clinical and nursing references for future washed microbiota transplantation applications in amyotrophic lateral sclerosis, and further randomized controlled trials are required to determine the safety and efficacy of WMT.