Graft Vs. Host Disease

Dr. Lauren Thorington

Dr. Cindy Rigsby

Children's Memorial Hospital

Abstract

Four month old with history of severe combined immunodeficiency disorder and recent bone marrow transplant with increasing abdominal distention.

Keywords

Graft vs Host


Publication Date: 2006-07-26

History

Four month old with history of severe combined immunodeficiency disorder and recent bone marrow transplant with increasing abdominal distention.

Findings

Periportal edema, ascites, gallbladder wall enhancement, multiple fluid filled, distended loops of small bowel with wall enhancement, mild enhancement of the urinary bladder wall.

Diagnosis

Acute Graft vs Host Disease

Discussion

Graft versus host disease is encountered among reciepients of bone marrow transplants performed for aplastic anemia, SCID, and leukemia. It may also occur with solid organ transplants, but is less common. Donor lymphoid cells trigger an immunologic reaction to the patient's skin, liver, lymphoid system, and GI tract. Symptoms develop in 30-90 days following the transplant and include a generalized skin rash, jaundice, and secretory diarrhea. Diffuse abnormalities of the small bowel develop with similar changes throughout the GI tract. There will be multiple fluid filled loops of large and small bowel with thickening and enhancement of the bowel wall. There may be similar enhancement of the gallbladder and urinary bladder walls. There may be infiltration of the mesenteric fat. The liver may be enlarged with periportal edema and possibly ascites.

References

  1. Donnelly, LF. Diagnostic Imaging Pediatrics. First Edition. 4:146-4:149.
  2. Franken, EA. Gastrointestinal Imaging in Pediatrics. Second Edition. 228.
  3. Gore, RM. Levine, MS. Gastrointestinal Radiology. Second Edition. 876-877.
  4. Donnelly, LF. Morris, CL. Acute Graft-versus-Host Disease in Children: Abdominal CT Findings. Radiology 1996; 199:265-268.
  5. Kuhn, JP. Slovis, TL. Haller, JO. Caffey's Pediatric Diagnostic Imaging. Tenth Edition. volume 2. 876-877.

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