Pericardial graft vs. host disease in a patient with myelodysplastic syndrome following peripheral blood stem cell transplantation

Abstract

A patient with myelodysplastic syndrome developed pericardial effusion 20 month after allogenic peripheral blood stem cell transplantation. Sclerotic and erythematous skin lesions were observed over the face and extremities, and a diagnosis of chronic graft vs. host disease (GVHD) was made based on skin biopsy findings. Pericardial fluid contained numerous CD8+/HLA-DR+ lymphocytes, but no leukaemic cells. Tumour necrosis factor alpha (TNFalpha) and soluble Fas (sFas) levels were highly elevated in both the effusion and serum. The patient was treated with methylprednisolone and tacrolimus. Skin GVHD improved rapidly associated with resolution of pericardial effusion and reductions in cytokine levels. We concluded that pericardial effusion was due to pericarditis and was a manifestation of chronic GVHD in this patient, and that cytotoxic lymphocytes and specific cytokines played significant roles.

Specific self-antigen-driven immune response in pericardial effusion as an isolated GVHD manifestation

“…Other presentations of pericardial effusion and cardiac tamponade usually have completely different mechanisms. 3 Similar to previous studies, 9,10 we found infiltration of mainly CD8 þ and HLA-DR þ , which indicates the function of cytotoxic T cells in inducing chronic GVHD. Interestingly, the pericardial effusion in our patient also contained a higher level of CD3 þ CD56 þ , suggestive of the presence of NKT cells.…”

“…Analysis of TCR clonality is of value in the diagnosis of T-cell immunodeficiencies and autoimmune diseases where there is expansion of certain T-cell clones evoked by malignancy or repeated exposure to a specific antigen or superantigen. 9 Indeed, GVHD is characterized by dominance of oligoclonal T-cell populations, reflecting specific antigen-driven immune responses. 13 We used different methods that included FACS analysis and TCR spectratyping to evaluate T-cell clonality in the pericardial effusion and PBMC of our patient.…”

Pericardial effusion post-SCT in pediatric recipients with signs and/or symptoms of cardiac disease

“…2 Pericardial effusion (PEF), a potentially morbid condition, is becoming a more recognized and frequently described complication that may not be associated with cardiac toxicity per se. [3][4][5][6][7][8][9][10] PEF after SCT was first reported in 1987 by Veys et al 10 They reported the case of a young woman with ALL who developed a PEF after conditioning for allogeneic BMT. They theorized that the effusion was secondary to cumulative cardiotoxicity from chemotherapy and radiation therapy.…”

“…At that time, the patient had evidence of both CMV infection and leukemia relapse, which were identified as the etiology of his PEF. 3 There have been numerous other case reports 6,8,9 but only one single retrospective review. 5 In this review, Rhodes et al 5 reported that the incidence of PEF in pediatric recipients after SCT was approximately 4.4%.…”

Pleuropericarditis, obliterative bronchiolitis and lymphocytic interstitial pneumonitis after allogeneic haematopoietic stem cell transplantation

“…A direct relation to GVHD was speculated but was difficult to confirm due to concurrent infection, prior or ongoing cytotoxic therapies or other medical (renal failure) conditions, which may have contributed to these events. Two previous case reports detail pericardial effusions occurring in the setting of chronic GVHD, however, in neither case was a biopsy performed 15 16. Thus, to our knowledge, a definite case of pleuritis due to chronic GVHD has not been previously reported.…”