title: Catastrophic graft-versus-host disease after lung transplantation proven by PCR-based chimerism analysis.
abstract: Acute graft-versus-host disease (GvHD) is a rare complication after solid organ transplantation. We describe a 52-year-old female developing neutropenia and fever 48 days after single lung transplantation for chronic obstructive pulmonary disease. Bone marrow (BM) biopsy suggested drug-induced marrow failure, so immunosuppression was reduced. Five days later a maculopapular skin rash was observed, progressing to a generalized erythema with desquamation. Skin biopsy was suspectable for GvHD, so immunosuppression was re-initiated. PCR-based chimerism analysis of BM revealed 78% donor cells. Intensified immunosuppression resulted in temporary improvement, but BM aplasia recurred and the patient experienced severe GvHD of gut and liver. Despite extensive immunosuppression the patient died from multi-organ failure 99 days after transplantation. This report describes the occurrence of neutropenia as an early presenting sign of acute GvHD after lung transplantation. We therefore recommend incorporating GvHD in the differential diagnosis of neutropenia after solid organ transplantation, calling for early chimerism analyses.
authors.affiliation: Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria. nina.worel@meduniwien.ac.at
authors.forename: Nina
authors.initials: N
authors.lastname: Worel
authors.forename: Andja
authors.initials: A
authors.lastname: Bojic
authors.forename: Michael
authors.initials: M
authors.lastname: Binder
authors.forename: Peter
authors.initials: P
authors.lastname: Jaksch
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Mitterbauer
authors.forename: Berthold
authors.initials: B
authors.lastname: Streubel
authors.forename: Florian
authors.initials: F
authors.lastname: Thalhammer
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Laczika
authors.forename: Gottfried J
authors.initials: GJ
authors.lastname: Locker