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November 1992

Two Cases of Transfusion-Associated Graft-vs-Host Disease After Open Heart Surgery

Author Affiliations

From the Departments of Dermatology (Drs K. Tanaka and Aki) and Anesthesiology (Dr A. Tanaka), Tottori (Japan) University Faculty of Medicine; the Department of Pathology, Shimane (Japan) Prefecture Central Hospital (Dr Nagasako); and the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Wash (Drs Shulman and Sullivan).

Arch Dermatol. 1992;128(11):1503-1506. doi:10.1001/archderm.1992.01680210081012

• Background.—  Some cases of blood transfusion— associated (TA) graft-vs-host disease (GVHD) in immunocompetent patients have been reported, but those dermatologic findings were not precisely mentioned. We describe patients with clinicopathologically TA-GVHD and compare TA-GVHD and acute GVHD after bone marrow transplantation.

Observations.—  Two cases of TA-GVHD after open heart surgery are reported. In both immunocompetent patients, severe erythema multiformelike skin rash developed over the entire body, followed by fever, diarrhea, jaundice, transaminitis, pancytopenia, and marrow alpasia approximately 10 days after the operation. The rash in one patient changed from erythema multiformelike to toxic epidermal necrolysis at death. Skin biopsy specimens revealed eosinophilic bodies, basal vacuolation, and exocytosis in the epidermis. Eosinophilic bodies tend to appear in the upper epidermis. Immunohistochemistry studies revealed that infiltrating cells were CD4 and CD8. While acute GVHD in immunosuppressed patients who have undergone bone marrow transplantations often shows lichenoid histologic features, TA-GVHD in our patients who were immunocompetent may resemble severe erythema multiforme or toxic epidermal necrolysis. The difference in TA-GVHD may be related to lack of host modification by immunosuppression.

Conclusions.—  Irradiation of the blood products should be required in open heart surgery, for TA-GVHD in immunocompetent patients is almost always fatal.(Arch Dermatol. 1992;128:1503-1506)

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