Pathology: graft vs. host disease (GVHD)

A 53 year old female received a bone marrow transplant for myelodysplastic syndrome 6 months ago.  She was diagnosed with GVHD of the skin 3 months ago.  Now, she presents with new rise in hepatocellular and cholestatic LFT, as well as increased bowel frequency.

Graft versus host disease typically effects skin, liver and gut.  Liver GVHD is often asymptomatic, and liver biopsy is used to make the diagnosis.  The histologic features are usually mild, with pauci-inflammation and biliary destruction being common.  Occasionally there is involvement with vasculature (when disease is more severe). 

It manifests in the gut with diarrhea; biopsies can be suggestive of this disease when taken from the small intestine or the colon.  Treatment involves immunosuppression, with steroids, mycophenolate mofetil, cyclosporin, or a combination thereof.  The photo here is of GVHD of the skin. 

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