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Case No. 506
2019-02-01~2019-02-28
출제자 : 배윤정
Hit : 311
| Period | 2019-02-01~2019-02-28 |
|---|---|
| Diagnosis | Cerebral GVHD (Graft-versus-host disease) |
| Gender |
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| Age | 45 |
| Clinical information | M/45Y Symptom: -Acute onset dysarthria and facial palsy -Seizure History: -Liver transplantation d/t liver cirrhosis -Post-craniotomy state d/t brain abscess after liver transplantation What is your diagnosis? |
| Discussion | Cerebral GVHD (Graft-versus-host disease) Imaging findings: -Multifocal or confluent white matter signal change -Ischemic lesions of different age -Small hemorrhagic foci -Multiple punctate and curvilinear enhancement Pathologic result from navigation-guided biopsy of the brain: -Angiocentric lymphocytic infiltration with extravasation of RBC and reactive gliosis c/w angiitis in small vessels, which is compatible finding for cerebral GVHD Cerebral GVHD following liver transplantation -Immunocompetent donor lymphocytes originating from the transplanted liver undergo activation and clonal expansion. -Destructive cellular immune response against recipient tissues is generated. -Cellular GVHD is directed against the major histocompatibility complex. -Uncommon complication with severe multisystem disease and high mortality -CNV involvement: Less common, in the form of cerebral angiitis, demyelination or diffuse infiltration of inflammatory cells -Cerebrovascular complications: Multifocal inflammatory perivascular lesions mainly around small-medium arteries in the meninges and the parenchyma with infiltrating cells of CD3+ and CD8+ cytotoxic T cells a. Large to medium vasculitis hemiparesis, aphasia, ischemic/hemorrhagic stroke b. Small vessel cerebral vasculitis headache, cognitive impairment, seizure |
| Correct answer |
Correct AnswerSemi-Correct Answer |