Buchan Alice, Merideth Melissa A, Childs Richard W, Stratton Pamela
Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
Gynaecology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
BMJ Case Rep. 2018 Apr 28;2018:bcr-2017-222720. doi: 10.1136/bcr-2017-222720.
Genital chronic graft-versus-host disease (GVHD) in women posthaematopoietic cell transplantation may cause vaginal mucosal sclerosis. Human papillomavirus (HPV) reactivation, also common post-transplantation, limits local immunosuppressive, but not oestrogen treatment. A 36-year-old nulliparous woman developed coincidental genital chronic GVHD and HPV 22 months after transplant for aplastic anaemia. Topical immunosuppression for GVHD led to an eruption of warts successfully treated with laser surgery and cone biopsy. She maintained normal ovarian function and used extended cycle combined hormonal contraception. A vaginal oestrogen ring used continuously limited most scarring for 8 years. Progressive apical vaginal scarring obstructed menstrual flow leading to haematocolpos and haematometra. Normal anatomy was restored with a cruciate incision in the cervicovaginal scar performed during menses. When HPV disease limits use of topical immunosuppression in women with vaginal GVHD, the local scar-reducing effect of a vaginal oestrogen ring is limited, and surgery may be needed and can be successful in treating haematocolpos.This study was registered in ClinicalTrials.gov with trial registration number of NCT00003838.
造血细胞移植后女性发生的生殖器慢性移植物抗宿主病（GVHD）可能导致阴道黏膜硬化。人乳头瘤病毒（HPV）再激活在移植后也很常见，它会限制局部免疫抑制，但不会影响雌激素治疗。一名36岁未生育女性在因再生障碍性贫血接受移植22个月后，同时发生了生殖器慢性GVHD和HPV感染。针对GVHD的局部免疫抑制治疗导致疣体爆发，经激光手术和锥形活检成功治疗。她维持了正常的卵巢功能，并采用了延长周期联合激素避孕法。持续使用阴道雌激素环在8年里最大限度地减少了瘢痕形成。阴道顶端瘢痕逐渐加重，阻碍月经血流出，导致阴道积血和子宫积血。在月经期间，通过对宫颈阴道瘢痕进行十字形切开，恢复了正常解剖结构。当HPV感染限制了阴道GVHD女性局部免疫抑制治疗的应用时，阴道雌激素环减少局部瘢痕的作用有限，可能需要手术治疗，且手术治疗阴道积血可能会成功。本研究已在ClinicalTrials.gov注册，试验注册号为NCT00003838。
