Chronic graft-versus-host disease after hematopoietic cell transplantation presenting as an acute hepatitis.
A variety of illnesses involving the gut and liver follow hematopoietic cell transplantation (HCT). A 20 yr-old white male developed severe acute hepatitis 36 wk (day 252) after matched, unrelated, allogeneic HCT for chronic myelogenous leukemia (CML). Mild skin graft-versus-host disease (GVHD) had occurred at about 20 wk (day 140) after transplant. Liver biopsy showed bile duct injury and a diffuse lobular injury pattern most consistent with a GVHD variant and not reminiscent of drug-induced or viral hepatitis. No findings suggestive of herpesvirus, adenovirus, or varicella-zoster virus were found. High-dose steroids resulted in marked improvement of his liver enzyme levels. We report this patient as representing the acute hepatitic presentation of chronic GVHD of the liver.
Malik
A H
AH
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75390-9151, USA.
Collins
R H
RH
Saboorian
M H
MH
Lee
W M
WM
D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000150:complications*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006505:Hepatitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D008099:Liver / Q000473:pathology; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D013997:Time Factors
D011241:Prednisone