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Previous Volume 354:1536-1537 April 6, 2006 Number 14 Next

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To the Editor: In 2002, a four-year-old boy who had been diagnosed with acute lymphoblastic leukemia in 1999 received a bone marrow transplant from his mother, who had three HLA-antigen mismatches and an incompatible blood type. After engraftment, an erythematous rash, diarrhea, and hepatomegaly, accompanied by elevated liver-enzyme levels, developed in the boy. The findings were indicative of acute graft-versus-host disease (GVHD) and led to intensified immunosuppressive therapy with mycophenolate mofetil and corticosteroids. Although the gut and skin GVHD improved, the hepatic GVHD persisted and was confirmed as chronic hepatic GVHD on liver biopsy (Figure 1A and Figure 1B. . . [Full Text of this Article]

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