Whalen Jason G, Jukic Drazen M, English Joseph C
Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
J Am Acad Dermatol. 2005 May;52(5):908-12. doi: 10.1016/j.jaad.2005.01.126.
Acute graft-versus-host disease is mainly a complication of allogeneic bone-marrow transplantation, and rarely seen after transplantation of solid organs. We describe a 68-year-old man who developed a maculopapular eruption and fever approximately 15 days after orthotopic liver transplantation for cryptogenic cirrhosis. At day 19, the patient developed abrupt neutropenia and diarrhea. Skin biopsy was performed and the specimen revealed basal cell layer vacuolization, necrotic keratinocytes, and satellite cell necrosis. Bone-marrow aspiration performed after the patient became pancytopenic revealed aplastic marrow with scattered lymphocytes and rare megakaryocytes. A diagnosis of acute graft-versus-host disease was made and an immunosuppressive drug regimen was initiated. Unfortunately, the patient died after support was withdrawn because of total ablation of his bone marrow and multiorgan failure. This report describes the rare presentation of acute graft-versus-host disease after solid organ transplantation, and that skin manifestations may be an early presenting sign.
急性移植物抗宿主病主要是同种异体骨髓移植的一种并发症，在实体器官移植后很少见。我们描述了一名68岁男性，在因隐源性肝硬化接受原位肝移植术后约15天出现斑丘疹和发热。在第19天，患者突然出现中性粒细胞减少和腹泻。进行了皮肤活检，标本显示基底细胞层空泡化、坏死角质形成细胞和卫星细胞坏死。患者出现全血细胞减少后进行的骨髓穿刺显示骨髓再生障碍，伴有散在淋巴细胞和罕见巨核细胞。诊断为急性移植物抗宿主病并开始免疫抑制药物治疗。不幸的是，由于患者骨髓完全消融和多器官功能衰竭，在撤除支持治疗后死亡。本报告描述了实体器官移植后急性移植物抗宿主病的罕见表现，且皮肤表现可能是早期表现体征。
