title: Fulminant skin GvHD with a cytokine pattern resemblant of cytokine release syndrome successfully treated with multimodal immunosuppression including tocilizumab.
abstract: Acute Graft-versus-Host-Disease (GvHD) is a potentially life-threatening complication after allogeneic stem cell transplantation. If not treated early and adequately, the complex immunological mechanisms may lead to a self-perpetuating cycle of alloreactivity, which is then associated with a high mortality. Here we assessed the cytokine profile on a daily basis in a patient with grade 4 skin GvHD, demonstrating a signature resembling cytokine-release-syndrome. After multimodal immunosuppressive intervention, including treatment with the IL6 receptor-blocking antibody tocilizumab, the severe clinical symptoms unexpectedly resolved within 48 hr.
authors.affiliation: University Hospital of Würzburg, Children's Hospital, Pediatric Stem Cell Transplantation, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Hellwig
authors.affiliation: University Hospital of Würzburg, Children's Hospital, Pediatric Stem Cell Transplantation, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany.
authors.forename: Young E
authors.initials: YE
authors.lastname: Yoo
authors.affiliation: University Hospital of Würzburg, Children's Hospital, Pediatric Stem Cell Transplantation, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany.
authors.forename: Marie L
authors.initials: ML
authors.lastname: Reß
authors.affiliation: University Hospital of Würzburg, Children's Hospital, Pediatric Stem Cell Transplantation, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Andres
authors.affiliation: University Hospital of Würzburg, Children's Hospital, Pediatric Stem Cell Transplantation, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Braun
authors.affiliation: University Hospital of Würzburg, Children's Hospital, Pediatric Stem Cell Transplantation, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Schlegel
authors.affiliation: University Hospital of Würzburg, Children's Hospital, Pediatric Stem Cell Transplantation, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wölfl
mesh_terms: D064591:Allografts; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D002648:Child; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007165:Immunosuppression Therapy; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000473:pathology / Q000628:therapy; D008297:Male; D012871:Skin Diseases / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D033581:Stem Cell Transplantation; D013577:Syndrome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C502936:tocilizumab
keywords: acute GvHD; cytokine profile; cytokine release syndrome; stem cell transplantation; tocilizumab