A Case of Colonic Graft-versus-Host Disease

摘要

A 52-year-old male patient diagnosed with acute promyelocytic leukemia type M3 was submitted to bone marrow transplant 6 months ago. He presented with watery diarrhea with mucus and without blood (6 bowel movements a day) for the past 2 months and had lost 5 kg since the beginning of the symptoms. At physical examination, the patient was pale and presented with a diffusely painful abdomen, without rebound tenderness. The laboratory test showed pancytopenia with elevation of the sedimentation rate and C-reactive protein. Stool samples were negative for pathogenic bacteria and parasites. Abdominal radiography showed no signs of pneumoperi toneum or hydro-aerial levels. An ileocolonoscopy was performed and revealed an ulcerated mucosa with detachable mucous and yellow pseudomembranes of the terminal ileum (Fig. ), cecum, and ascending colon (Fig. , ); the remaining colonic segments were normal. Multiple biopsies were performed and revealed ulceration and focal apoptosis, aspects compatible with graft versus host disease.