title: Two cases of transfusion-associated graft-vs-host disease after open heart surgery.
abstract: BACKGROUND
  Some cases of blood transfusion-associated (TA) graft-vs-host disease (GVHD) in immunocompetent patients have been reported, but those dermatologic findings were not precisely mentioned. We describe patients with clinicopathologically TA-GVHD and compare TA-GVHD and acute GVHD after bone marrow transplantation.
  
  
  METHODS
  Two cases of TA-GVHD after open heart surgery are reported. In both immunocompetent patients, severe erythema multiformelike skin rash developed over the entire body, followed by fever, diarrhea, jaundice, transaminitis, pancytopenia, and marrow alpasia approximately 10 days after operation. The rash in one patient changed from erythema multiformelike to toxic epidermal necrolysis at death. Skin biopsy specimens revealed eosinophilic bodies, basal vacuolation, and exocytosis in the epidermis. Eosinophilic bodies tend to appear in the upper epidermis. Immunohistochemistry studies revealed that infiltrating cells were CD4 and CD8. While acute GVHD in immunosuppressed patients who have undergone bone marrow transplantations often shows lichenoid histologic features, TA-GVHD in our patients who were immunocompetent may resemble severe erythema multiforme or toxic epidermal necrolysis. The difference in TA-GVHD may be related to lack of host modification by immunosuppression.
  
  
  CONCLUSIONS
  Irradiation of the blood products should be required in open heart surgery, for TA-GVHD in immunocompetent patients is almost always fatal.
authors.affiliation: Department of Dermatology, Tottori University Faculty of Medicine, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Aki
authors.forename: H M
authors.initials: HM
authors.lastname: Shulman
authors.forename: K M
authors.initials: KM
authors.lastname: Sullivan
authors.forename: A
authors.initials: A
authors.lastname: Tanaka
authors.forename: R
authors.initials: R
authors.lastname: Nagasako
mesh_terms: D000368:Aged; D001855:Bone Marrow Diseases / Q000209:etiology / Q000473:pathology; D006348:Cardiac Surgical Procedures; D004817:Epidermis / Q000473:pathology; D004892:Erythema Multiforme / Q000209:etiology* / Q000473:pathology; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D065227:Transfusion Reaction