Open AccessExocrine pancreatic insufficiency and graft-versus-host disease
Author(s) -
Julia López Cardona,
Carla Senosiaín Lalastra,
Francisco Mesonero Gismero,
Irene García de la Filia Molina,
Sergio Escribano Cruz,
Gonzalo Trigo Gallego,
Agustı́n Albillos
Publication year - 2022
Publication title -
revista española de enfermedades digestivas/revista española de enfermedades digestivas
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.331
H-Index - 38
eISSN - 2340-4167
pISSN - 1130-0108
DOI - 10.17235/reed.2022.9143/2022
Subject(s) - medicine , steatorrhea , exocrine pancreatic insufficiency , gastroenterology , graft versus host disease , calprotectin , diarrhea , pancreatitis , immunology , disease , inflammatory bowel disease
We present the case of a 59-year-old man with acute myeloid leukemia treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Two years later, he consulted for diarrhea and steatorrhea of 2-3 months of evolution with significant weight loss. Stool cultures and study of parasites were negative. Thyroid and celiac profile, cytomegalovirus viremia and colonoscopy, were normal. Fecal calprotectin and fecal clearance of alpha-1-Antitrypsin were normal but with almost undetectable fecal elastase (<15 ug/g). Pancreatic magnetic resonance reveals a generalized atrophy of the pancreas without other parenchymal or ductal alterations. The patient had no risk factors for chronic pancreatitis and was diagnosed with exocrine pancreatic insufficiency (EPI) associated with chronic graft-versus-host disease (GVHD). GVHD is caused by an immune-mediated reaction by donor T cells recognizing foreign antigens from the recipient. GVHD occurs in 80% of patients after allo-HSCT. Diarrhea is one of the most frequent manifestations, most often due to intestinal damage, opportunistic infections or chemoradiation effects.