Diagnosis -- GraftVersusHost Disease (GVHD)
- DIAGNOSIS:
- Biochemical parameters suggestive of Graftversushost disease, with extensive hepatocellular damage.
Notes:
Histologic examination of the liver was not performed at this time.
The patient has a clinical history of prior biopsy proven GVHD episodes.
- Graftversushost disease (GVHD) can be seen following bone marrow and/or solid organ transplantation. The
disease occurs in immunocompromised patients, who when transplanted, receive "passenger" lymphocytes in the transplanted
bone marrow or solid organ. These lymphocytes recognize the recipient's tissue as foreign. Thus, they attack
and mount an inflammatory and destructive response
in the recipient. GVHD has a predilection for epithelial tissues, especially skin,
liver, and mucosa of the gastrointestinal tract. This can lead to severe skin disease (ulcerations, etc.), GI hemorrhage
and liver failure. In addition, people with GVHD are especially susceptible to infection.
- This patient had reported prior episodes of GVHD. She presented with hemoptysis and signs of infection. Sequential
laboratory evaluation revealed an impressive increase in liver enzymes, especially LDH and ALT (markers of cellular
injury). This was followed by increase in total bilirubin and GGTP (markers of cholestasis). These findings are typical
for acute hepatocellular injury, in this case related to GVHD involvement of the liver, with cellular destruction.
Contributed by Nelson Geraldino, M.D. and Jeff Nine, M.D.
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