Three weeks after allogeneic bone marrow transplantation, a patient develops maculopapular rash on palms and soles, watery diarrhea, and jaundice with rising bilirubin. Biopsy of affected tissue shows apoptosis of epithelial cells with lymphocytic infiltrate. Which cells initiate this complication?

• A Donor mature T lymphocytes ✓
• B Recipient dendritic cells
• C Recipient natural killer cells
• D Donor plasma cells

Explanation

Acute graft-versus-host disease occurs when immunocompetent mature T lymphocytes in the donor marrow recognize recipient HLA antigens as foreign and mount a cytotoxic response against host tissues. The classic target organs are skin, gastrointestinal tract, and liver, producing rash, diarrhea, and cholestatic jaundice with apoptotic epithelial cells on biopsy. Recipient NK cells and dendritic cells cannot cause GVHD because the graft is the source of the attacking immune cells, and donor plasma cells are not involved in acute rejection-like injury.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.