Intact survival with transfusion-associated graft-versus-host disease proved by human leukocyte antigen typing of lymphocytes in skin biopsy specimens,☆☆,

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Abstract

A transient transfusion-associated graft-versus-host disease occurred in a premature infant of 30 weeks of gestation. We demonstrated donor lymphocytes in a skin biopsy specimen with a two-step immunoperoxidase technique using monoclonal antibodies against human leukocyte antigen determinants specific for the donor. The girl survived and is immunocompetent. (J P EDIATR 1995;126: 61-4)

Section snippets

CASE REPORT

After 30 weeks of gestation a female premature infant was delivered by cesarean section to healthy parents. The mother was Rh negative and the father was Rh positive. It was the mother's fifth pregnancy; the first had no complications, and anti-D prophylaxis was not administered. The second child and the third child had hemolytic disease of the newborn and required postnatal transfusions or exchange transfusion. A fourth pregnancy ended in abortion. During the fifth pregnancy the mother's

Immunohistologic studies of frozen sections

We used a two-step immunoperoxidase technique to incubate monoclonal antibodies against supertypic HLA epitopes (class I and class II), Langerhans cells (CD1), T lymphocytes (CD3, CD4, CD8, and CD25), and against subtypic HLA-A and B-alleles8, 9 on acetone-fixed sections of fresh-frozen skin. We found a complete absence of CD1+ dendritic cells, a homogeneous HLA-DR expression of epidermal keratinocytes, and predominance of CD8 + T cells in the epidermotropic infiltrate. Anti-HLA-A1 antibody

DISCUSSION

In addition to marked eosinophilia, the leading clinical criterion for the diagnosis of GVHD in this infant was the skin manifestation.2, 5, 6 However, toxic drug reactions, viral infections (especially cytomegalovirus), and septicemia may produce similar rashes.6 Even histologic and routine immunohistologic examination of a skin biopsy specimen, though quite typical, is not specific for TGVHD; similar alterations can be found in toxic drug reactions and after chemotherapy or radiation

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From the Departments of Pediatrics, Dermatology, and Obstetrics and Gynecology, University Hospital, Münster, Germany; the Department of Dermatology, University Hospital, Würzburg, Germany; the Department of Pediatrics, University Hospital, Ulm, Germany; and the Institute of Immunology, University of Kiel, Kiel, Germany.

☆☆

Reprint requests: R. Hentschel, MD, Department of Pediatrics, University of Münster, Albert-Schweitzer-Str. 33, 48129 Münster, Germany.

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