title: Rash and pancytopenia as initial manifestations of acute graft-versus-host disease after liver transplantation.
abstract: Acute graft-versus-host disease is mainly a complication of allogeneic bone-marrow transplantation, and rarely seen after transplantation of solid organs. We describe a 68-year-old man who developed a maculopapular eruption and fever approximately 15 days after orthotopic liver transplantation for cryptogenic cirrhosis. At day 19, the patient developed abrupt neutropenia and diarrhea. Skin biopsy was performed and the specimen revealed basal cell layer vacuolization, necrotic keratinocytes, and satellite cell necrosis. Bone-marrow aspiration performed after the patient became pancytopenic revealed aplastic marrow with scattered lymphocytes and rare megakaryocytes. A diagnosis of acute graft-versus-host disease was made and an immunosuppressive drug regimen was initiated. Unfortunately, the patient died after support was withdrawn because of total ablation of his bone marrow and multiorgan failure. This report describes the rare presentation of acute graft-versus-host disease after solid organ transplantation, and that skin manifestations may be an early presenting sign.
authors.affiliation: Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Whalen
authors.forename: Drazen M
authors.initials: DM
authors.lastname: Jukic
authors.forename: Joseph C
authors.initials: JC
authors.lastname: English
mesh_terms: D000368:Aged; D005076:Exanthema / Q000209:etiology*; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000175:diagnosis*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D010198:Pancytopenia / Q000209:etiology*
chemical_list: D007166:Immunosuppressive Agents