A renal transplant recipient develops fever, maculopapular rash starting on the palms and soles, diarrhoea and deranged liver enzymes six weeks after receiving a liver transplant simultaneously from the same cadaveric donor. Lymphocytes within the graft are attacking recipient tissues. What is the diagnosis?

• A Graft versus host disease ✓
• B Acute cellular rejection of the transplanted organs
• C Post-transplant lymphoproliferative disorder
• D Chronic rejection with vanishing bile ducts

Explanation

Graft versus host disease occurs when immunocompetent donor lymphocytes recognise recipient tissues as foreign; it presents with rash involving palms and soles, gastrointestinal symptoms and hepatotoxicity. In solid organ transplantation it is rare because lymphocyte numbers in the graft are small, but multi-organ grafts carry higher risk. Rejection is host against graft and does not produce this pattern. PTLD is an EBV-driven lymphoid proliferation presenting as a mass.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.