Severe acute graft-versus-host disease of conjunctivae after allogeneic blood progenitor cell infusion.

A 37-year-old woman with Philadelphia chromosome-positive acute lymphoblastic leukemia received allogeneic bone marrow transplants after first and second relapses from different HLA-identical brothers. After a third relapse, blood progenitor cells from one of the brothers were infused after six doses of cytarabine 1.5 g/m2 in an attempt to induce a graft-versus-leukemia effect. Seven weeks after the infusion, the patient developed delayed but severe acute graft-versus-host disease (GVHD) including the unusual manifestation of conjunctival involvement.

Clinical and subclinical ophthalmic findings with retinol deficiency.

BACKGROUND: Patients at risk for retinol deficiency in developed countries include those with hepatic dysfunction and malabsorption states. Symptoms of retinol deficiency may go unrecognized or unreported. METHODS: The authors describe 15 patients with hepatic dysfunction, two of whom had procedures that would predispose to malabsorption and were ophthalmologically symptomatic of retinol depletion. The other 13 patients were ophthalmologically asymptomatic liver transplant candidates examined prospectively for subclinical evidence of retinol deficiency. Combined laboratory analysis, Schirmer's testing, conjunctival impression cytology, and electroretinography were performed. RESULTS: Twelve of 15 patients had serum retinol levels below the lower limit of normal. Aqueous tear production was reduced in 7 of 14 patients. Abnormal conjunctival morphology was noted in 6 of 12 patients. Electroretinograms were abnormal in the two patients who were visually symptomatic and in seven of nine patients who were ophthalmologically asymptomatic. CONCLUSION: Subclinical, physiologically significant retinol deficiency may be a frequent and unrecognized problem among patients with hepatic dysfunction.