[Graft versus host disease in a human T cell leukemia virus-I carrier]

A 24 year-old woman developed severe congestive heart failure due to combined aortic and mitral valve failures associated with infectious endocarditis. She was operated on double valve replacement. At the open heart surgery, 7 units of blood were transfused. Her postoperative course was complicated with LOS and renal failure. She recovered gradually with assistance of intraaortic balloon pumping and hemodialysis. High fever, diarrhea, skin rash and impaired liver function appeared on the 10th postoperative day. Neither leukocytopenia or pancytopenia was seen. In blood cultures, organism was negative and endotoxemia was also negated after operation. Erythroderma developed rapidly after desquamation of skin rash. The skin sample showed the typical features which were observed in a graft-versus-host (GVH) disease. The patient died of cerebral bleeding on the 32nd postoperative day. In the HLA typing, two unmatched antigens of class II were exhibited in her lymphocyte sample but all of class I were matched. Y-chromatin was not detected in her lymphocytes. Anti-nuclear antibody was positive. The fact is noteworthy that she and her parents were human T lymphotropic virus-I (HTLV-I) carriers. In the literature, HTLV-I is activated in the immunocompromised state and yields alien antigens of major histocompatibility complex (MHC) in T cells, then the reaction is very similar to it in autoimmune disease. That mechanism may be involved in the cause of GVH reaction in our case. These results suggested that the GVH reaction in our case.(ABSTRACT TRUNCATED AT 250 WORDS)