Transfusion-associated-graft-vs-host disease in a presumed immunocompetent patient.
Since the advent of bone marrow transplantation, a vexing clinical problem is that of acute graft-vs-host disease (GVHD). A less well-recognized disorder is that of GVHD in patients receiving blood products containing immunocompetent lymphocytes. Transfusion-associated (TA)-GVHD has a lower incidence and higher mortality (greater than 90%) than bone marrow transplantation-GVHD and until now has been limited to patients with hereditary or acquired immunologic deficits and to patients immunocompromised by chemotherapy for malignant neoplasms. We presently describe a patient who underwent coronary artery bypass graft surgery and who suffered what we believe was TA-GVHD. This diagnosis is supported by considering the chronology of events (in particular, blood transfusion), clinical features (fever, rash, abnormal results of liver function tests, diarrhea, and pancytopenia), and a skin biopsy specimen that revealed basal cell vacuolation and lymphocyte satellitosis that are considered characteristic for this disorder. We believe TA-GVHD can occur in previously immunocompetent patients who receive transfusions of blood products containing functioning lymphocytes and that this awareness will lead to the discovery of additional cases and a better understanding of this disorder.
Arsura
E L
EL
Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219.
Bertelle
A
A
Minkowitz
S
S
Cunningham
J N
JN
Grob
D
D
D000208:Acute Disease; D001026:Coronary Artery Bypass; D003937:Diagnosis, Differential; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D010198:Pancytopenia / Q000209:etiology; D012871:Skin Diseases / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D013997:Time Factors; D065227:Transfusion Reaction