title: Graft-versus-host disease: unexpected presentation with simultaneous hepatitis and pancreatitis.
abstract: We report the case of a 37-year-old man with a previous bone marrow transplantation presenting with abdominal pain, diarrhoea and jaundice. Laboratory evaluation showed marked elevated liver enzymes, amylase and lipase with ultrasonographic evidence of acute alithiasic pancreatitis. Liver biopsy was compatible with graft-versus-host disease and toxic hepatitis. The patient rapidly improved after increasing immunosuppression. Although gastrointestinal manifestations are common in graft-versus-host disease, clinical acute pancreatitis is rarely seen. Patients with graft versus host are seldom managed by gastroenterologists and hepatologists. An awareness of this condition is essential for the experienced clinician.
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Samuel Raimundo
authors.initials: SR
authors.lastname: Fernandes
authors.affiliation: Pathology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors.forename: Antonio T
authors.initials: AT
authors.lastname: Alves
authors.affiliation: Serviço de Medicina Interna, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Margarida Barreto
authors.initials: MB
authors.lastname: Cortes
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Cortez-Pinto
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003967:Diarrhea / Q000209:etiology; D006086:Graft vs Host Disease / Q000150:complications*; D006505:Hepatitis / Q000209:etiology*; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008297:Male; D010195:Pancreatitis / Q000209:etiology*