title: Bullous pemphigoid after liver transplantation for liver failure.
abstract: Coomb's positive autoimmune hemolytic anemia with giant cell hepatitis (GCH) is a rare cause of liver failure and is usually associated with poor prognosis. A child with liver kidney microsomal (LKM) antibody positivity underwent successful liver transplantation for liver failure secondary to GCH with Coomb's positive hemolytic anemia. Autoimmune neutropenia developed ten months after transplant. Four months later, pemphigoid skin lesions developed. The diagnosis of bullous pemphigoid (BP) was made on the basis of skin biopsy, direct and indirect immunofluorescence test results. Treatment was with immunosuppressants - prednisone and azathioprine/rapamycin, with addition of dapsone when lesions persisted. This child is unique in that his liver function and hemolytic anemia appeared to normalize after liver transplant, but neutropenia and BP both thought to be autoimmune in etiology, developed more than a year post-transplant.
authors.affiliation: Division of Pediatric Hepatology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA. Nanda.Kerkar@msnyuhealth.org
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
authors.forename: Steven
authors.initials: S
authors.lastname: Cohen
authors.forename: Christina
authors.initials: C
authors.lastname: Dugan
authors.forename: Raffaella A
authors.initials: RA
authors.lastname: Morotti
authors.forename: Robert G
authors.initials: RG
authors.lastname: Phelps
authors.forename: Betsy
authors.initials: B
authors.lastname: Herold
authors.forename: Benjamin
authors.initials: B
authors.lastname: Shneider
authors.forename: Sukru
authors.initials: S
authors.lastname: Emre
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000503:physiopathology; D015726:Giant Cells / Q000473:pathology; D006505:Hepatitis / Q000150:complications / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008099:Liver / Q000503:physiopathology; D017093:Liver Failure / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D010391:Pemphigoid, Bullous / Q000188:drug therapy / Q000209:etiology*; D011184:Postoperative Period; D020127:Recovery of Function
chemical_list: D007166:Immunosuppressive Agents