ABSTRACT
UNLABELLED: The graft versus host disease after liver transplant is rare, with an incidence less than 1%, but with a high mortality (75-85%), especially due to infectious complications. It usually affects gastrointestinal tract, skin and blood system in the context of a normal liver graft function. There is no consensus on the most appropriate treatment: some articles support a reduction or even elimination of immunosuppressive drugs, while others published success with a dose increase. CLINICAL CASE: We report a case of a 68 year-old liver transplant recipient with a graft retrieved from an ABO identical cadaveric donor. After an uneventful postoperative period, he was readmitted presenting these symptoms: skin lesions, diarrhea and kidney failure. After ruling out infectious causes or drug toxicity, skin, duodenum and colon biopsies demonstrated characteristic histological changes of graft versus host disease grade III. Initially, supportive treatment along with methylprednisolone bolus were administered with good response. However, as the doses of corticosteroids decreased, the patient worsened again, requiring basiliximab. In spite of that, the patient progressively worsened with hematological involvement and, finally, an alteration of liver function tests prior to decease. The autopsy showed CMV and Herpes virus superinfection. DISCUSSION: We report a new case of graft-versus-host disease after liver transplantation with fatal evolution due to viral superinfection despite the employed measures.
Subject(s)
Graft vs Host Disease/etiology , Liver Transplantation/adverse effects , Aged , Antibodies, Monoclonal/therapeutic use , Basiliximab , Cytomegalovirus Infections/complications , Fatal Outcome , Graft vs Host Disease/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Male , Recombinant Fusion Proteins/therapeutic use , Steroids/therapeutic useABSTRACT
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Subject(s)
Humans , Male , Adult , Graft vs Host Disease/complications , Graft vs Host Disease/pathology , Therapeutics/methods , Pharmaceutical Preparations/administration & dosage , Liver Cirrhosis, Alcoholic/complications , Liver Cirrhosis, Alcoholic/genetics , Intestinal Diseases/pathology , Graft vs Host Disease/diagnosis , Graft vs Host Disease/metabolism , Therapeutics/instrumentation , Pharmaceutical Preparations , Liver Cirrhosis, Alcoholic/rehabilitation , Liver Cirrhosis, Alcoholic/therapy , Intestinal Diseases/metabolismABSTRACT
Testicular germ cell tumors, though rare (1%), represent the most common neoplasm among young men. Gastrointestinal involvement from these malignancies usually presents as bowel obstruction and digestive bleeding, but their frequency is low (5%). The patterns of this involvement are: infiltration from affected retroperitoneal lymph nodes or, less frequently, by peritoneal seeding and direct hematogenous spread. Particularly, infiltration of duodenum is also rare, though its real frequency is not well defined. Moreover, the affinity for GI tract differs among the histological types of GCT, being seminomatous tumors an exceedingly unfrequent cause of duodenal infiltration. We herein present a recent case in our institution of severe anemia due to gastrointestinal bleeding in the context of giant retroperitoneal bulky metastatic mass infiltrating duodenum as first manifestation of a testicular pure seminoma.
Subject(s)
Duodenal Neoplasms/secondary , Neoplasms, Germ Cell and Embryonal/pathology , Seminoma/secondary , Testicular Neoplasms/pathology , Adult , Duodenal Neoplasms/diagnostic imaging , Duodenal Neoplasms/pathology , Gastrointestinal Hemorrhage/etiology , Gastroscopy , Humans , Male , Neoplasms, Germ Cell and Embryonal/diagnostic imaging , Neoplasms, Germ Cell and Embryonal/surgery , Seminoma/diagnostic imaging , Seminoma/pathology , Testicular Neoplasms/diagnostic imaging , Testicular Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
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