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Tytuł pozycji:

Critical digital ischemia and biliary cholangitis related to graft versus host disease: A case report and systematic literature review.

Tytuł:
Critical digital ischemia and biliary cholangitis related to graft versus host disease: A case report and systematic literature review.
Autorzy:
Hidalgo Calleja C; Rheumatology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain.
Montilla Morales CA; Rheumatology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain.
Sánchez González MD; Rheumatology Department, Hospital Clínico Universitario de Valladolid, Spain.
Pastor Navarro S; Rheumatology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain.
Ibáñez Martínez M; Rheumatology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain.
Conde Ferreiros A; Dermatology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain.
López Corral L; Haematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain.
Źródło:
Medicine [Medicine (Baltimore)] 2023 Jan 13; Vol. 102 (2), pp. e32495.
Typ publikacji:
Systematic Review; Case Reports; Journal Article
Język:
English
Imprint Name(s):
Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins
MeSH Terms:
Hematopoietic Stem Cell Transplantation*/adverse effects
Graft vs Host Disease*/complications
Graft vs Host Disease*/diagnosis
Cholangitis*/complications
Bronchiolitis Obliterans Syndrome*
Scleroderma, Systemic*/complications
Scleroderma, Systemic*/therapy
Humans ; Female ; Middle Aged ; Transplantation, Homologous/adverse effects ; Ischemia/complications ; Chronic Disease
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Entry Date(s):
Date Created: 20230113 Date Completed: 20230117 Latest Revision: 20230118
Update Code:
20240105
PubMed Central ID:
PMC9839287
DOI:
10.1097/MD.0000000000032495
PMID:
36637943
Czasopismo naukowe
Rationale: Chronic graft versus host disease (cGVHD) is a systemic immune-mediated complication that occurs in approximately half of patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT), and remains the leading cause of late morbidity and mortality. cGVHD involves a heterogeneous group of organic manifestations, many of which mimic autoimmune diseases such as scleroderma, primary biliary cholangitis, Sjögren syndrome and polymyositis.
Patient Concerns: A 60-years-old female with a history of allo-HCT developed de novo cGVHD 11 months after allo-HCT with isolated liver involvement. The patient presented with jaundice, cytolysis, cholestasis and concomitant acute digital ischemia. Liver biopsy and autoimmunity tests were performed and were found to be compatible with immune-mediated liver damage. Nailfold capillaroscopy revealed microangiopathy, characterized by avascular areas and some enlarged capillaries resembled an early systemic sclerosis pattern.
Diagnosis: Biliary cholangitis-like and digital ischemia related to cGVHD.
Interventions: The patient was treated with high-dose prednisone and ursodeoxycholic acid, and extracorporeal photopheresis. The patient required hospital admission for administration of intravenous prostacyclin due to refractory Raynaud syndrome.
Outcomes: After 6 to 8 weeks, the patient achieved a good response, with evident clinical improvement and progressive normalization of liver function.
Lessons: cGVHD is a multiorgan pathological condition, and this case emphasizes that a multidisciplinary team, including rheumatologists, should be involved in the follow-up of allo-transplant patients to ensure that the clinical complications are adequately addressed. Early intervention is critical for improving patient' prognosis.In addition, we performed a systemic literature review based on published case articles on hepatic cGVHD and digital ischemia published up to August 2022. To the best of our knowledge, this is the first reported case of such an association.
Competing Interests: The authors have no funding and conflicts of interest to disclose.
(Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

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