Soeda K, Onoda S, Kozu T, Okuyama K, Koide Y, Isono K
Department of Surgery, Chiba University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1990 Aug;91(8):1040-3.
A 72 year-old Japanese male with esophageal cancer underwent esophagectomy. After seemingly uneventful recovery, he developed high fever on 11 post-operative day (POD), rashes over the whole body on 13 POD and leukopenia on 15 POD. On 22 POD, thrombopenia and parenchymal bleeding of lungs were noted. He died on 26 POD after progressive hypoxia and hypotension. HLA type of peripheral lymphocytes on him changed homozygously to that of the transfused fresh blood. Skin biopsy showed mild leukocyte infiltration in the epidermis and the dyskeratotic keratinocytes were associated with a contiguous lymphocyte, the so-called satellite cell necrosis. In the findings of autopsy, aplastic bone marrow and atrophied spleen, whose weight was 14g, were noted. Based on the clinical picture, skin biopsy and HLA study findings, we diagnosed this case as post-transfusion GVHD. We think that high age, operative injury and preoperative irradiation might be inducement to reveal post-transfusion GVHD in this case.
一名72岁的日本男性食管癌患者接受了食管切除术。术后恢复看似顺利，但术后第11天出现高热，术后第13天全身出现皮疹，术后第15天出现白细胞减少。术后第22天，发现血小板减少和肺部实质出血。在进行性缺氧和低血压后，他于术后第26天死亡。他外周淋巴细胞的HLA类型同型转变为所输注新鲜血液的HLA类型。皮肤活检显示表皮有轻度白细胞浸润，角化不良的角质形成细胞与相邻淋巴细胞相关，即所谓的卫星细胞坏死。尸检结果显示骨髓再生障碍和脾脏萎缩，脾脏重量为14克。根据临床表现、皮肤活检和HLA研究结果，我们将该病例诊断为输血后移植物抗宿主病。我们认为高龄、手术损伤和术前放疗可能是该病例发生输血后移植物抗宿主病的诱因。
