Bone marrow engraftment and associated dermatologic sequelae in a three-yr-old after liver transplantation

作者：Sheu Johanna; Saavedra Arturo P; Degar Barbara A; Duncan Christine N; Fawaz Rima; Tan Jennifer K; Schmidt Birgitta A; Kim Heung B; Huang Jennifer T^*

来源：Pediatric Transplantation, 2015, 19(2): E41-E46.

DOI：10.1111/petr.12412

• chimerism
• liver transplantation
• bone marrow engraftment
• post-transplant
• autoimmune
• Langerhans cell histiocytosis

We present a case of a three-yr-old child with a history of multisystem Langerhans cell histiocytosis treated with systemic chemotherapy, who developed progressive liver failure and received an orthotopic split liver transplant while continuing on chemotherapy. Onemonth following transplant, he developed acute graft-vs.-host disease of the skin and gastrointestinal tract. Peripheral blood chimerism studies post-transplant demonstrated an increasing predominance of donor lymphocytes and granulocytes. Shortly after, the patient developed vitiligo, and twoyr after transplantation, the patient developed skin manifestations of psoriasis. We discuss and review the current literature, which demonstrates that chimerism following liver transplantation is rare and in our patient may be related to his profound immunosuppression around the time of liver transplant as well the development of acute graft-versus-host disease. While autoimmune disease can occur after solid organ and stem cell transplant, our patient developed skin manifestations of autoimmunity after liver transplantation, which is also rarely described.

• 出版日期2015-3