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Atypical acute rejection after hand transplantation.
S Schneeberger1, V S Gorantla, R P van Riet
1Department of General Surgery, Innsbruck Medical University, Innsbruck, Austria.
Summary
Atypical skin rejection after hand transplantation involves palms and nails, unlike the classical pattern. This novel presentation requires specific management beyond standard immunosuppression.
Area of Science:
- Immunology
- Dermatology
- Transplantation Surgery
Background:
- Hand transplantation is a complex procedure with potential for immune rejection.
- Classical skin rejection presents as a rash on forearms and hands, sparing palms and nails.
Observation:
- Four cases of atypical skin rejection following hand transplantation were observed.
- This novel pattern involved palmar skin and nails, differing from the classical presentation.
- Patients experienced desquamative rash, dry skin, papules, scaling, lichenification on palms, and nail dystrophy.
Findings:
- Histology revealed T-cell predominant lymphocytic infiltrate in skin and nail beds.
- Lesions were persistent, resistant to steroids, and required intensified immunosuppression.
- Antithymocyte globulin (ATG) and alemtuzumab were effective in managing these atypical rejections.
Implications:
- Recognizing atypical skin rejection patterns is crucial for timely diagnosis and effective treatment.
- This finding expands the understanding of hand transplant rejection manifestations.
- Novel therapeutic strategies may be needed for managing palmar and nail involvement in hand transplant rejection.
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