Acute Graft-vs-Host Disease After Liver Transplantation in a Patient Presenting With Neurogenic Symptoms as the Single Primary Manifestation: A Case Report.

Acute graft-vs-host disease (aGVHD) is a rare but deadly complication after liver transplantation (LT). It occurs when donor immunocompetent cells transplanted with the liver allograft repopulate and recognize recipient antigens as foreign and mount an alloreactive response. aGVHD patients can present with skin rash, fever, diarrhea, and pancytopenia. These nonspecific symptoms are usually misleading, delaying the diagnosis of aGVHD. Here, we present a patient who developed severe aGVHD after LT, with neurogenic symptoms as the first manifestation. Symptoms including fever, skin rash, diarrhea, and pancytopenia appeared several days later. A skin biopsy revealed dermal lymphocyte infiltration. A bone marrow chimerism test showed 99.87% liver donor cells. The patient was treated with high doses of methylprednisolone (360 mg a day), Rabbit anti-T lymphocyte immunoglobulin (300 mg per day), and antithymocyte globulin (40 mg per day). Unfortunately, the patient died of multiple organ failure at 47 days after transplantation. To our knowledge, this is the first case of aGVHD after LT with neurogenic symptoms as the single primary manifestation and also with the highest level of donor cells (>99%) in bone marrow chimerism test ever reported.