Turk J Hematol. 2005; 22(1): 45-48

Case report of two haematopoietic stem cell transplanted patients with chronic graft-versus-host disease resembling acute viral hepatitis

Şeniz Öngören¹, Zafer Başlar¹, Teoman Soysal¹, Cem M. Ar¹, Abdullah Sonsuz², Gülşen Özbay³, Burhan Ferhanoğlu^1
1Department Of Internal Medicine Section Of Haematology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
²Department Of Internal Medicine Section Of Hepatology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
³Department Of Pathology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

Chronic graft-versus-host disease (GVHD) of the liver usually presents as an indolent cholestatic syndrome associated with abnormalities in the skin, oral mucosa, and lacrimal glands observed beyond day 100 after allogeneic bone marrow transplantation. Because of its cholestatic nature, chronic liver GVHD is not generally considered in the differential diagnosis of markedly elevated serum transaminases and jaundice. However, sudden rise in serum transaminase levels after day 70 posttranplant should always raise the question of chronic liver GVHD. We report here two cases, in whom the presentation of chronic graft-versus-host disease of the liver strongly resembled acute viral hepatitis. Chronic GVHD of the liver should also be taken into account in the differential diagnosis of marked elevations of liver enzymes in allogeneic stem cell transplant recipients and appropriate diagnostic and therapeutic measures should be applied.

Keywords: Graft-versus-host disease, Haematopoietic stem cell transplantation, Hepatitis.

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Akut viral hepatiti taklit eden ve kronik greft versus host hastalığı olan iki hematopoietik kök hücre nakli olgusu

Şeniz Öngören¹, Zafer Başlar¹, Teoman Soysal¹, Cem M. Ar¹, Abdullah Sonsuz², Gülşen Özbay³, Burhan Ferhanoğlu^1
1Department Of Internal Medicine Section Of Haematology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
²Department Of Internal Medicine Section Of Hepatology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
³Department Of Pathology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

Karaciğerde kronik graft-versus-host hastalığı (GVHH) genellikle allogeneik kemik iliği transplantasyonunu izleyen 100. günden sonra ortaya çıkan kolestatik karaciğer fonksiyon bozukluğu, cilt ve oral mukoza lezyonları ile karakterize bir tablodur. Kolestatik komponentin ön planda olması sebebiyle, akut gelişen sarılık ve artmış transaminaz düzeyleri söz konusu olduğunda ayırıcı tanıda kronik GVHH öncelikli olarak yer almaz. Ancak bazen posttransplant geç dönemde gelişen akut hepatit kronik GVHH’nin ilk bulgusu olabilir. Bu yazıda, kronik GVHH’nin akut viral hepatit benzeri bir tablo ile ortaya çıktığı iki olgumuzu sunuyoruz.

Anahtar Kelimeler: Graft versus host hastalığı, Hematopoietik kök hücre nakli, Hepatit.

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