Six weeks after orthotopic liver transplantation, a recipient presents with fever, a maculopapular rash spreading from the trunk to the limbs, profuse watery diarrhoea, and pancytopenia. Peripheral smear shows no abnormal lymphocytes and EBV viral load is undetectable. Biopsy of skin shows apoptotic keratinocytes with donor-derived lymphocytic infiltration. What is the diagnosis?
- A Acute graft-versus-host disease arising from donor passenger lymphocytes in the graft ✓
- B Post-transplant lymphoproliferative disorder
- C Drug eruption from sulfonamide prophylaxis
- D Cytomegalovirus syndrome with colitis
Correct answer: A. Acute graft-versus-host disease arising from donor passenger lymphocytes in the graft
Explanation
Graft-versus-host disease after liver transplantation results from donor lymphocytes carried in the graft mounting an immune attack on the recipient, producing fever, rash, diarrhoea and pancytopenia with very high mortality. Demonstration of donor-derived lymphocytes confirms the diagnosis. PTLD is distinguished by EBV positivity and A-cell masses rather than pancytopenia with apoptotic epithelial injury, which is the fact that separates it from the correct answer.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.