title: Fatal graft-versus-host disease presenting as fever of unknown origin in a pancreas-after-kidney transplant recipient.
abstract: Acute graft-versus-host disease (GVHD) is a rare complication of pancreas transplantation. We describe a 54-year-old male with type 1 diabetes who received a zero-antigen mismatched pancreas-after-kidney transplant from a pancreas donor who was homozygous at the HLA-B, -Cw, -DR, and -DQ alleles. Starting on postoperative day (POD) #22, the patient developed persistent fevers. Workup was notable only for low-grade cytomegalovirus viremia, which was treated. The fevers eventually disappeared. On POD #106, the patient was noted to have a diffuse erythematous rash. A skin biopsy was consistent with GVHD. Short tandem repeat DNA analysis of both peripheral blood lymphocytes and skin demonstrated mixed chimerism, confirming the diagnosis of GHVD. Soon after diagnosis, the patient developed pancytopenia and fevers and died of multiorgan failure on POD #145. Transplant clinicians should consider GVHD as a possible, although admittedly rare, cause of fevers of unknown origin in recipients of pancreas transplants.
authors.affiliation: Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA. fweng@sbhcs.com
authors.forename: F L
authors.initials: FL
authors.lastname: Weng
authors.forename: C
authors.initials: C
authors.lastname: Pancoska
authors.forename: A M
authors.initials: AM
authors.lastname: Patel
mesh_terms: D017809:Fatal Outcome; D005335:Fever of Unknown Origin / Q000209:etiology*; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D016035:Pancreas Transplantation / Q000009:adverse effects*