TRANSFUSION-ASSOCIATED GRAFT-VERSUS-HOST DISEASE DIAGNOSED BY POLYMERASE CHAIN-REACTION ANALYSIS OF DNA MICROSATELLITES - AN AUTOPSY CASE WITH IMMUNOHISTOCHEMICAL INVESTIGATION

In autopsy case of transfusion-associated graft-versus-host disease (T A-GVHD) is reported with immunohistochemical investigation and polymer ase chain reaction (PCR) analysis. In a 58-year-old male, esophagectom y for carcinoma was performed with a transfusion of 4 units of fresh w hole blood. Diarrhea, fever, erythematous rash, pain and leukopenia oc curred with an onset 11 days after the operation. He died of sudden dy spnea 29 days after the operation. At autopsy, histological examinatio ns revealed lichenoid lesion in the skin, injury of mucosal epithelia in the digestive tract and damage of interlobular bile ducts in the li ver. Immunohistochemical investigation suggested the association betwe en these lesions and CD8-positive T lymphocytes. Severe disturbances o f bone marrow and lymphoid organs were accompanied with gram-positive cocci infection in the lungs, esophagus and small intestine. PCR analy sis of DNA at microsatellite loci, human growth hormone (HGH) and apol ipoprotein B (Apo B), showed DNA chimerism and established the definit ive diagnosis of TA-GVHD.