Postoperative erythrodermia (POED), a type of graft-versus-host reaction (GVHR)?

Postoperative erythrodermia (POED) is a rare disease appearing several days after surgery for which blood transfusion has been required, characterized by erythrodermia, fever, pancytopenia, hepatic insufficiency or diarrhea. Most affected patients die within four weeks. The etiology remains unknown, but some assume it to be a type of graft-versus-host reaction (GVHR) caused by transfused lymphocytes. In this study, skin biopsies taken from 9 POED patients were examined to clarify whether POED is a type of GVHR. In seven samples, changes compatible with GVHR, such as lymphocyte infiltration in the basal layer and occasional eosinophilic or vacuolar degeneration of the epidermal cells, with occasional satellitosis, were noted. Immunopathologically, infiltrating lymphocytes mostly expressed suppressor/cytotoxic T cell markers like those in GVHR. Meanwhile, immunostaining with anti-HLA-A type specific antibodies failed to differentiate infiltrating lymphocytes from host cells. Thus, the present morphologic and in vivo marker study suggested POED to be a type of GVHR, while in vivo HLA-A typing showed two contradictory possibilities: first, that POED is a GVHR in which major histocompatibility antigen-matched donor lymphocytes attack host cells, and secondly that POED is not a GVHR, the infiltrating lymphocytes being of host origin.