Hepatic graft-versus-host disease resembling acute hepatitis: additional treatment with ursodeoxycholic acid

Authors

  • Tetsuhiro Chiba,

    1. Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan,
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  • Osamu Yokosuka,

    1. Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan,
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  • Tatsuo Kanda,

    1. Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan,
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  • Kenichi Fukai,

    1. Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan,
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  • Fumio Imazeki,

    1. Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan,
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  • Hiromitsu Saisho,

    1. Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan,
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  • Miki Nishimura,

    1. Department of Medicine Genome Research and Clinical Application, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan
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  • Yasushi Saito

    1. Department of Medicine Genome Research and Clinical Application, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan
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Osamu Yokosuka, MD, Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan. Tel: 81 43 2262083. Fax: 81 43 2262088.
e-mail: yokosuka@med.m.chiba-u.ac.jp

Abstract

Abstract: Hepatic graft-versus-host disease (GVHD) is a frequent complication after bone-marrow transplantation (BMT). The disease is often refractory to immunosuppressive therapy. We present a 30-year-old Japanese male, who developed an abrupt elevation of aminotransferases, on day 135 after allogeneic BMT. A liver biopsy specimen revealed degeneration of the small bile ducts and portal fibrosis, and the diagnosis of chronic hepatic GVHD was confirmed. No manifestation of chronic GVHD was observed except liver dysfunction. The administration of prednisolone (PSL) and cyclosporin (CsA) ameliorated laboratory data to a degree, but they did not return to normal. Treatment with ursodeoxycholic acid (UDCA), subsequently added to the immunosuppressive therapy, apparently normalized the levels of biliary tract enzyme and total bilirubin. His liver function test completely returned to normal on day 260. We believe that it is worthwhile to administer UDCA as an additional treatment for not only common hepatic GVHD but also atypical cases presenting as acute hepatitis.

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