A Case of Rejection of Bone Marrow Transplant

Image Source: The New England Journal of Medicine

A young man with leukaemia underwent a bone marrow transplant, but his body rejected this treatment!

A young male in his 20s was suffering from acute myeloid leukaemia. His leukaemia was refractory to all treatment. Therefore, he underwent a stem-cell transplant from a mismatched, unrelated donor. Around three weeks after the transplantation, doctors diagnosed him with graft rejection; to be specific, grade 4 acute graft-versus-host disease (GVHD) involving the skin, digestive tract, and liver.

Then, around 1 month after the transplant he started having itching in his both eyes along with tearing.

Graft versus host disease (GVHD) is the immune response of the donor graft/organ against the recipient’s body. This happens when the immune cells (T-cells) of the donor organ attack the patient’s normal cells of the body. This can affect many organs of the body just as seen in this patient. Acute GVHD can affect the skin, liver and gastrointestinal tract. Patients may present with rashes, blistering, nausea, vomiting, diarrhoea, jaundice, dryness of mouth, eyes, and skin. The most difficult among these is the gastrointestinal reaction and it is the most common cause of GVHD-related mortality.

This reaction can be acute or chronic. The reaction can be mild, moderate or severe. It can be life-threatening too.

This patient received a diagnosis within 3 weeks of his transplant.

On examination, his vision was normal and so were the corneas. However, the doctors noticed pseudomembranes of the upper and lower conjunctivae. They removed the pseudomembranes of one eye.

Histopathological evaluation revealed fibrinous exudates, macrophages, and solitary granulocytes. However, there were no microorganisms.

This confirmed the diagnosis of grade 3 acute ocular GVHD. The doctors started the patient on topical prednisolone.

Acute ocular GVHD with pseudomembranes is a complication of stem-cell transplantation. Moreover, it has a poor prognosis.

The main aim of management was to prevent conjunctival scarring. Therefore, the pseudomembranes on his eyes were regularly removed until they no longer appeared. This took around 3 weeks of treatment.

With glucocorticoids and immunosuppression, he achieved remission of acute GVHD.

However, 1 year later, he developed moderate chronic GVHD involving the skin, mouth, eyes, and fascia.

Source: The New England Journal of Medicine

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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