A 37-year-old man received a bone marrow transplant 2 weeks previously for acute myelogenous leukemia. Two days ago, itching, diarrhea, pain and numbness in his palms and soles, and the skin lesions shown here developed. Each of the following statements about this condition is true except:
Acute Graft-Versus-Host Disease
Answer: a
• Occurs 7 to 21 days after transplantation
• Donor T cells attack host HLA antigens
• Mean frequency in adults with HLA-identical grafts is 35%
• Risk factors include the following:
Increased age
HLA mismatch
Sex mismatch (female donor, male recipient)
Irradiation
Suboptimal immunosuppression
• Affects the skin, gastrointestinal tract, and liver
• Pruritus and pain may be the first sensations, commonly followed by an erythematous measles-like maculopapular exanthem. Acral erythematous lesions may develop on palms, soles, and ears
• Blistering and exfoliation are common
• Digestive tract involvement may present (from less severe to more) as nausea, vomiting, anorexia, diarrhea, malabsorption, abdominal pain, ileus, and ascites
• Values on liver function tests are often increased; jaundice and hepatomegaly may develop
• Treatment involves intensifying immunosuppression, such as high-dose corticosteroids, cyclosporine, and cyclophosphamide
• Severe cases (grade IV) have a high mortality rate (>80%)
