Graft versus host reaction. An ultrastructural study

Area of Science:

• Dermatology
• Immunology
• Oncology

Background:

• Graft versus host reaction (GvH) is a serious complication following leukocyte transfusions.
• Generalized lymphosarcoma patients are at risk for GvH.
• Dyskeratotic cells in the epidermis are a key indicator of GvH.

Observation:

• Histologic and ultrastructural studies examined dyskeratotic cells in a patient with lymphosarcoma experiencing GvH.
• Dyskeratotic cells exhibited dense tonofilament aggregation, organelle inclusion, and desmosome loss.
• Intracellular desmosomes and phagocytosis by keratinocytes were also observed.

Findings:

• The observed cellular changes in dyskeratotic cells suggest toxic epidermal damage due to the GvH immunologic phenomenon.
• These alterations contribute to the characteristic features of GvH reaction in the epidermis.
• Later clinical presentation included bullae formation, resembling toxic epidermal necrolysis (TEN) and GvH.

Implications:

• Understanding the ultrastructural basis of dyskeratotic cells enhances GvH diagnosis.
• This research deepens insights into the immunopathology of GvH and its dermatologic manifestations.
• Identifying GvH-induced epidermal changes may inform therapeutic strategies for transfusion complications.