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A rare but life-threatening complication in liver transplant recipients.

Raszeja-Wyszomirska J, Wasilewicz MP, Szydłowska-Jakimiuk M, Grzelak I, Figiel W, Sachs W, Niewiński G, Gierej B, Ziarkiewicz-Wróblewska B, Krawczyk M - Prz Gastroenterol (2015)

View Article: PubMed Central - PubMed

Affiliation: Liver and Internal Medicine Unit, Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.

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Graft versus host disease (GvHD) occurs in as little as 1–2% of cases after liver transplantation (LT), but is probably under-diagnosed and under-reported... Skin rash, diarrhoea, and/or fever are early symptoms of GvHD, and the most common causes of death are sepsis or gastrointestinal bleeding as a result of bone-marrow involvement... All stool bacterial cultures were negative, including Clostridium difficile toxaemia, cytomegalovirus, and Epstein-Barr virus infections... Because of the patient's history of ulcerative colitis, rectosigmoidoscopy was performed showing moderate exacerbation of the disease, confirmed by the result of a colonic biopsy... Unfortunately, the symptomatic treatment was ineffective, with a persistent high number of stools per day, with elevation of CRP, fibrinogen and dyselectrolytaemia, anaemia, and decreasing counts of leucocytes and platelets... Fever, skin rash, diarrhoea, severe bone marrow suppression, and gastrointestinal bleeding beginning 2 to 6 weeks after liver transplantation (LT) are clinical manifestations of acute GvHD... However, GvHD after LT is less responsive to corticosteroids than GvHD after stem cell transplantation... Based on the literature, both major strategies – augmentation or withdrawal of immunosuppressant therapy – seem to be ineffective in GvHD treatment, so we decided to apply a novel approach with interleukin 2-receptor antibody basiliximab... With the other supportive care we saw an improvement in the patient's general condition; however, fungal sepsis developed with the need of immunosuppression reduction... Although GvHD is a rare complication after LT, it can lead to significant mortality, deepen by the delay of diagnosis and the lack of efficacious treatment... Clinical features represent an important tool for early diagnosis... Further research is needed to provide new therapeutic agents for treating this condition effectively.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan of abdomen with swelling of the intestine
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Figure 0002: Computed tomography scan of abdomen with swelling of the intestine

Mentions: A 45-year-old patient, six weeks after liver transplantation because of primary sclerosing cholangitis (PSC), was admitted to the hospital due to watery diarrhoea. The patient presented dehydration with more than 20 watery, periodically bloody stools with spastic mid-abdominal pain, slight elevation of body temperature, and merging redness rush on feet and hands. C-reactive protein (CRP) was reached more than 300 mg/dl. All stool bacterial cultures were negative, including Clostridium difficile toxaemia, cytomegalovirus, and Epstein-Barr virus infections. Because of the patient's history of ulcerative colitis, rectosigmoidoscopy was performed showing moderate exacerbation of the disease, confirmed by the result of a colonic biopsy. Unfortunately, the symptomatic treatment was ineffective, with a persistent high number of stools per day, with elevation of CRP, fibrinogen and dyselectrolytaemia, anaemia, and decreasing counts of leucocytes and platelets. His maculopapular rush developed occupying also the abdomen, chest, and back (Figures 1 A, B). Computer tomography revealed inflammation of both small and large intestines with ascites (Figure 2). The patient was treated with tacrolimus (drug blood levels of 8–12 ng/ml), basiliximab (20 mg i.v. in day 0 and 4), and methylprednisolone 500 mg IV q.d. for 3 days, subsequently with oral prednisolone and budesonide, antibiotics, and antifungal drugs as well as with intravenous colloids, crystalloids, human albumin, ions, and nutritional support. However, general vasculitis and multiorgan failure, secondary to fungal sepsis, developed and the patient died 30 days after onset.


A rare but life-threatening complication in liver transplant recipients.

Raszeja-Wyszomirska J, Wasilewicz MP, Szydłowska-Jakimiuk M, Grzelak I, Figiel W, Sachs W, Niewiński G, Gierej B, Ziarkiewicz-Wróblewska B, Krawczyk M - Prz Gastroenterol (2015)

Computed tomography scan of abdomen with swelling of the intestine
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4814535&req=5

Figure 0002: Computed tomography scan of abdomen with swelling of the intestine
Mentions: A 45-year-old patient, six weeks after liver transplantation because of primary sclerosing cholangitis (PSC), was admitted to the hospital due to watery diarrhoea. The patient presented dehydration with more than 20 watery, periodically bloody stools with spastic mid-abdominal pain, slight elevation of body temperature, and merging redness rush on feet and hands. C-reactive protein (CRP) was reached more than 300 mg/dl. All stool bacterial cultures were negative, including Clostridium difficile toxaemia, cytomegalovirus, and Epstein-Barr virus infections. Because of the patient's history of ulcerative colitis, rectosigmoidoscopy was performed showing moderate exacerbation of the disease, confirmed by the result of a colonic biopsy. Unfortunately, the symptomatic treatment was ineffective, with a persistent high number of stools per day, with elevation of CRP, fibrinogen and dyselectrolytaemia, anaemia, and decreasing counts of leucocytes and platelets. His maculopapular rush developed occupying also the abdomen, chest, and back (Figures 1 A, B). Computer tomography revealed inflammation of both small and large intestines with ascites (Figure 2). The patient was treated with tacrolimus (drug blood levels of 8–12 ng/ml), basiliximab (20 mg i.v. in day 0 and 4), and methylprednisolone 500 mg IV q.d. for 3 days, subsequently with oral prednisolone and budesonide, antibiotics, and antifungal drugs as well as with intravenous colloids, crystalloids, human albumin, ions, and nutritional support. However, general vasculitis and multiorgan failure, secondary to fungal sepsis, developed and the patient died 30 days after onset.

View Article: PubMed Central - PubMed

Affiliation: Liver and Internal Medicine Unit, Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Graft versus host disease (GvHD) occurs in as little as 1–2% of cases after liver transplantation (LT), but is probably under-diagnosed and under-reported... Skin rash, diarrhoea, and/or fever are early symptoms of GvHD, and the most common causes of death are sepsis or gastrointestinal bleeding as a result of bone-marrow involvement... All stool bacterial cultures were negative, including Clostridium difficile toxaemia, cytomegalovirus, and Epstein-Barr virus infections... Because of the patient's history of ulcerative colitis, rectosigmoidoscopy was performed showing moderate exacerbation of the disease, confirmed by the result of a colonic biopsy... Unfortunately, the symptomatic treatment was ineffective, with a persistent high number of stools per day, with elevation of CRP, fibrinogen and dyselectrolytaemia, anaemia, and decreasing counts of leucocytes and platelets... Fever, skin rash, diarrhoea, severe bone marrow suppression, and gastrointestinal bleeding beginning 2 to 6 weeks after liver transplantation (LT) are clinical manifestations of acute GvHD... However, GvHD after LT is less responsive to corticosteroids than GvHD after stem cell transplantation... Based on the literature, both major strategies – augmentation or withdrawal of immunosuppressant therapy – seem to be ineffective in GvHD treatment, so we decided to apply a novel approach with interleukin 2-receptor antibody basiliximab... With the other supportive care we saw an improvement in the patient's general condition; however, fungal sepsis developed with the need of immunosuppression reduction... Although GvHD is a rare complication after LT, it can lead to significant mortality, deepen by the delay of diagnosis and the lack of efficacious treatment... Clinical features represent an important tool for early diagnosis... Further research is needed to provide new therapeutic agents for treating this condition effectively.

No MeSH data available.


Related in: MedlinePlus