Absence of peripheral blood chimerism in graft-vs-host disease following orthotopic liver transplantation: case report and review of the literature.
Int J Dermatol
; 53(11): e492-8, 2014 Nov.
Article
in En
| MEDLINE
| ID: mdl-24372059
ABSTRACT
BACKGROUND:
Graft-vs-host disease (GVHD) is a rare and often fatal complication of orthotopic liver transplantation (OLT). The skin is frequently involved early in disease progression, but clinical and histopathological features may be nonspecific, presenting a diagnostic challenge. While the detection of peripheral blood chimerism has been proposed as a diagnostic criterion for post-OLT GVHD, it is not known whether peripheral blood chimerism is an absolute requirement for the diagnosis. MATERIALS ANDMETHODS:
We report a case of a 57-year-old man who developed post-OLT GVHD with cutaneous, enteric, and bone marrow involvement. We also review the epidemiology, pathogenesis, clinical presentation, histopathology, molecular diagnostic techniques, and treatment of GVHD following liver transplantation.RESULTS:
In our patient, analysis of the peripheral blood by short-tandem repeat polymerase chain reaction did not detect circulating donor lymphocytes. Donor lymphocytes were detected in the buccal mucosa, however, confirming the diagnosis. A review of chimerism patterns in 63 previously published cases of post-OLT GVHD reveals that this is the first reported case in which chimerism was absent in the peripheral blood but present in another site.CONCLUSIONS:
Peripheral blood chimerism may be absent in cases of post-OLT GVHD. A combination of clinical, histopathological, and molecular features is therefore required to make this challenging diagnosis.
Full text:
1
Database:
MEDLINE
Main subject:
Skin Diseases
/
Chimerism
/
Graft vs Host Disease
Limits:
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Int J Dermatol
Year:
2014
Type:
Article
Affiliation country:
United States