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Absence of peripheral blood chimerism in graft‐vs‐host disease following orthotopic liver transplantation: case report and review of the literature
Author(s) -
Schulman Joshua M.,
Yoon Christina,
Schwarz Jennifer,
Vagefi Parsia A.,
Mully Thaddeus W.,
Shinkai Kanade
Publication year - 2014
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.12149
Subject(s) - medicine , graft versus host disease , pathology , liver transplantation , transplantation , microchimerism , bone marrow , immunology , disease , histopathology , complication , peripheral blood , pregnancy , fetus , genetics , biology
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 and methods 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.