Graft-versus-host disease | Figure 1

Graft-versus-host disease

Coronal contrast enhanced abdominal CT in a patient status post bone marrow transplant shows diffuse wall thickening (arrow) of ileal and colonic loops consistent with graft versus host disease. Graft versus host disease is an immune-related complication of bone marrow transplant where the transplanted immune system attacks the recipient tissues. The skin is most commonly affected. However, this is usually not visible on imaging. On imaging, the most commonly affected organ is the gastrointestinal tract where bowel wall thickening may be present.

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1. Coronal (image 1) and sagittal (image 2) T1-weighted images focused on the pituitary show a thickened proximal infundibulum (arrow) with increased signal and narrowing distally. Langerhans' cell histiocytosis can rarely affect the central nervous system. When the central nervous system is affected, it most commonly appears as thickening of the infundibulum. Patients may present with diabetes insipidus.

2. \n A 32-year-old man with primary marrow failure is being prepared for bone marrow transplant. The operation is successful, but 2 to 3 days after the procedure, the patient complains of severe diarrhea, which contains a significant amount of blood and mucus. The attending intern notices some yellowing of the skin and orders liver function tests. Serum bilirubin is elevated, and all the liver enzymes are above the normal levels. The patient also develops erythematous macules that are beginning to turn necrotic. What is the most likely reason for this patient’s current medical condition?\n A. Acute graft-versus-host disease (GVHD)\n B. Chronic GVHD\n C. Hyperacute marrow rejection\n D. Acute transplant rejection\n E. Chronic graft rejection\n Question from Immunology for Medical Students, 3rd Edition. ISBN: 9780702068010. Copyright © 2017 by Elsevier, Inc.

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