Donor lymphocyte infusion induced acute hepatitis.
Hepatic graft-versus-host disease (GVHD) post allogeneic hematopoietic stem cell transplantation generally presents as cholestatic jaundice and increased serum alkaline phosphatase (ALK-P). Currently accepted standards for evaluating the clinical severity of hepatic GVHD are not based on serum aminotransferase levels but on the serum bilirubin levels. We describe a 25-year-old female who initially had no liver damage at all after an allogeneic peripheral blood stem cell transplantation (allo-PBSCT) from her HLA-indentical sister. Markedly elevated aminotransferases, without hyperbilirubinemia, however, developed 7 and 9 weeks after the first and second donor lymphocyte infusion (DLI), respectively. Liver biopsies performed in both events revealed lymphocytic infiltration of the portal tracts and pericentral necrosis of the lobuli. There was also a picture of periductal lymphocytic infiltration and vacuolization of the biliary epithelial cells, which was compatible with the diagnosis of GVHD of cholangiohepatitic type. These findings indicate that hepatic GVHD may present as acute hepatitis and should be included in the differential diagnosis for patients with increased aminotransferases after DLI.
You
Jie-Yu
JY
Division of Hematology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Yu
Yuan-Bin
YB
Chen
Paul Chih-Hsueh
PC
Tsay
Shyh-Haw
SH
Chen
Chih-Cheng
CC
Ho
Chao-Hung
CH
Chau
Wing-Keung
WK
Hsu
Hui-Chi
HC
Gau
Jyh-Pyng
JP
Tzeng
Cheng-Hwai
CH
D000208:Acute Disease; D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology*; D006505:Hepatitis / Q000209:etiology*; D006801:Humans; D017710:Lymphocyte Transfusion / Q000009:adverse effects*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D014019:Tissue Donors