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Donor lymphocyte infusion induced acute hepatitis
Jie-Yu You1, Yuan-Bin Yu, Paul Chih-Hsueh Chen
1Division of Hematology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Journal of the Chinese Medical Association : JCMA
|November 24, 2004
Summary
Hepatic graft-versus-host disease (GVHD) can manifest as acute hepatitis with elevated aminotransferases, not just jaundice. This finding is crucial for diagnosing GVHD in patients post-donor lymphocyte infusion (DLI).
Area of Science:
- Hepatology
- Transplantation Immunology
Background:
- Hepatic graft-versus-host disease (GVHD) typically presents with cholestatic jaundice and elevated alkaline phosphatase post-allogeneic hematopoietic stem cell transplantation (allo-HSCT).
- Current diagnostic standards for hepatic GVHD focus on bilirubin levels, potentially overlooking other presentations.
Observation:
- A 25-year-old female developed markedly elevated aminotransferases without hyperbilirubinemia after donor lymphocyte infusions (DLI) following allo-PBSCT.
- Liver biopsies revealed lymphocytic infiltration and necrosis, consistent with GVHD of the cholangiohepatitic type.
Findings:
- Hepatic GVHD can present as acute hepatitis characterized by elevated aminotransferases.
- This presentation occurred in the absence of hyperbilirubinemia, challenging conventional diagnostic criteria.
Implications:
- Elevated aminotransferases post-DLI should prompt consideration of hepatic GVHD in the differential diagnosis.
- This expands the recognized clinical spectrum of hepatic GVHD, aiding earlier detection and management.
- Highlights the importance of liver biopsy in diagnosing atypical GVHD presentations.