Transient posttransplant graft-versus-host lymphadenopathy.
There is sparse information in humans on graft-versus-host (GVH) lymphadenopathy. A 15-month-old male received a liver and small bowel transplant for short bowel after gastroschisis. At 21 days he developed a GVH-like skin rash. Flow cytometry demonstrated 16.1% circulating donor cells. Polymerase chain reaction for Epstein-Barr virus was negative. Two months later, the rash recurred with diffuse lymphadenopathy. Lymph node biopsy showed effaced architecture without visible follicles, large numbers of CD79a(+) immunoblasts interspersed with smaller CD3(+) and CD8(+) cells, and prominent dendritic cell hyperplasia. Human herpes virus 8, cytomegalovirus, and EBER-1 probes were negative, as was polymerase chain reaction for human herpes virus 6. Allograft intestinal biopsies on days 10 and 24 had a similar infiltrate. The features appeared to be those of lymphocytes trafficking between the graft and host with a mixed lymphocyte reaction in situ, a GVH-type reaction without tissue damage. The reaction was self-limiting in the intestinal graft, and the lymphadenopathy resolved with some decrease in immunosupression. Circulating donor cells fell to 2.5% by day 62, and the child has been rejection free on low-dose immunosuppression.
Nodit
Laurentia
L
Department of Pathology, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA.
Murase
Noriko
N
Reyes
Jorge D
JD
Mazariegos
George V
GV
Sindhi
Rakesh
R
Jaffe
Ronald
R
D003937:Diagnosis, Differential; D005434:Flow Cytometry; D020139:Gastroschisis / Q000601:surgery; D006086:Graft vs Host Disease / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation; D016031:Liver Transplantation / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology; D008206:Lymphatic Diseases / Q000209:etiology* / Q000473:pathology*; D008297:Male; D012075:Remission, Spontaneous