Hepatic graft-versus-host disease presenting as an acute hepatitis after allogeneic peripheral blood stem cell transplantation

Hepatic graft-versus-host disease (GVHD) generally presents as cholestatic jaundice, and increased serum alkaline phosphatase (ALP) is followed by hyp erbilirubinemia and clinical jaundice. Currently accepted standards for eva luating the clinical severity of GVHD are based not on serum aminotransfera se levels but on the serum bilirubin level. We describe a 17-year-old Japan ese female who had increased aminotransferases without cholestasis on day 2 3 after allogeneic peripheral blood stem cell transplantation (allo-PBSCT), Liver biopsy revealed lymphocytic infiltration of the portal tracts and pe ricentral necrosis of the lobuli, The limiting plates were not clearly defi ned due to cellular infiltrates. There was periductal lymphocytic infiltrat ion and vacuolization of the biliary epithelial cells with exocytosis, comp atible with GVHD of cholangiohepatitic type. These findings indicate that a cute hepatic GVHD may present as acute hepatitis and this should be include d in the differential diagnosis for patients with increased aminotransferas es after allogeneic stem cell transplantation.