Hepatic graft-versus-host disease resembling acute hepatitis: additional treatment with ursodeoxycholic acid.
Hepatic graft-versus-host disease (GVHD) is a frequent complication after bone-marrow transplantation (BMT). The disease is often refractory to immunosuppressive therapy. We present a 30-year-old Japanese male, who developed an abrupt elevation of aminotransferases, on day 135 after allogeneic BMT. A liver biopsy specimen revealed degeneration of the small bile ducts and portal fibrosis, and the diagnosis of chronic hepatic GVHD was confirmed. No manifestation of chronic GVHD was observed except liver dysfunction. The administration of prednisolone (PSL) and cyclosporin (CsA) ameliorated laboratory data to a degree, but they did not return to normal. Treatment with ursodeoxycholic acid (UDCA), subsequently added to the immunosuppressive therapy, apparently normalized the levels of biliary tract enzyme and total bilirubin. His liver function test completely returned to normal on day 260. We believe that it is worthwhile to administer UDCA as an additional treatment for not only common hepatic GVHD but also atypical cases presenting as acute hepatitis.
Chiba
Tetsuhiro
T
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan.
Yokosuka
Osamu
O
Kanda
Tatsuo
T
Fukai
Kenichi
K
Imazeki
Fumio
F
Saisho
Hiromitsu
H
Nishimura
Miki
M
Saito
Yasushi
Y
D000208:Acute Disease; D000328:Adult; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006086:Graft vs Host Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006505:Hepatitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
D002756:Cholagogues and Choleretics; D007166:Immunosuppressive Agents; D014580:Ursodeoxycholic Acid; D016572:Cyclosporine; D011239:Prednisolone