Acute transaminitis as an atypical presentation of Graft-versus-Host Disease following Hematopoietic Stem Cell Transplantation

Resham Ramkissoon, Akshay Shetty, Adam Doyle, Oyedele A. Adeyi, Keyur Patel


Graft versus Host Disease (GVHD) can present with mucocutaneous, gastrointestinal and hepatic manifestations, specifically a cholestatic transaminitis. Rarely, some cases can present with only a hepatocellular transaminitis. Our patient presented with an acute hepatitis on day +90 post-hematopoietic stem cell transplant, without other overt manifestations of GVHD. The initial work up was negative for a viral etiology or causative drug, and the patient’s transaminases continued to rise. On day +96, an erythematous rash appeared with biopsy indicating lymphocytic and eosinophilic infiltrates concerning for cutaneous GVHD. Subsequently, a liver biopsy was obtained, and showed marked ductopenia with cholestasis, consistent with hepatic GVHD. 

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Case Reports in Clinical Pathology

ISSN 2331-2726(Print)  ISSN 2331-2734(Online)

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