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Old 06-13-2012
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Question Leukemic Patient with Rash and Jaundice!

A 35-year-old woman who has been in the hospital receiving treatment for leukemia has developed an extensive, scaling rash over the past week. A skin biopsy specimen shows keratinocyte apoptosis along the dermal-epidermal junction, with upper dermal lymphocytic infiltrates. She also has jaundice. This patient has most likely recently undergone which of the following procedures?

A) Tuberculin skin testing
B) Chemotherapy for malignant lymphoma
C) Allogenic bone marrow transplantation
D) Penicillin therapy for pneumonia
E) Patch testing for allergen detection

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Old 06-13-2012
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Default c

i would go with c
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Old 06-14-2012
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think its penicillin's effect, rash with skin exfoliation and jaundice.
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Old 06-14-2012
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C. Its GVHD.
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Old 06-14-2012
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Quote:
Originally Posted by Casandra View Post
A 35-year-old woman who has been in the hospital receiving treatment for leukemia has developed an extensive, scaling rash over the past week. A skin biopsy specimen shows keratinocyte apoptosis along the dermal-epidermal junction, with upper dermal lymphocytic infiltrates. She also has jaundice. This patient has most likely recently undergone which of the following procedures?

A) Tuberculin skin testing
B) Chemotherapy for malignant lymphoma
C) Allogenic bone marrow transplantation
D) Penicillin therapy for pneumonia
E) Patch testing for allergen detection

Graft versus host disease usually occurs 85% in case of bone marrow transplantation where immunocompetent donor lymphocyte causes clinical findings like jaundice(bile duct necrosis),dermatitis evident from skin biopsy.
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Old 06-14-2012
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It is c
Replacement of host marrow by immunocompetent donor cells capable of mounting an inflammatory reaction against the-"foreign" tissue antigens of the host. GVHR of specific host organs—skin, liver, or GI tract. Severity of GVHD related to histocompatibility match between donor and recipient and preparatory regimen used.

Dermatopathology - GVHD
Focal vacuolization of basal cell layer, apoptosis of individual keratinocytes; mild perivenular mononuclear cell infiltrate. Apposition of lymphocytes to necrotic keratinocytes (satellitosis); vacuoles coalesce to form subepidermal clefts subepidermal blister formation. Endothelial cell swelling. Immunocytochemistry: HLA-DR expression of keratinocytes precedes morphologic changes and thus represents important,
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Old 06-14-2012
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Default correct answer :)

Correct answer is C) Allogenic bone marrow transplantation

This patient hsa graft-versus-host disease. The engrafted marrow contains immunocompetent cells that can proliferate and attack hosttissues, usually skin, liver and gastrointestinal epithelium.
Tuberculin skin testing is a form of delayed-type of hypersensitivity.
Some chemotherapy agents can produce a drug reaction with more acute inflammation than described in this case.
Urticaria with type I hypersensitivity is a typical reaction to penicilin therapy.
Patch testing is done to determine the type of allergens to which atopic persons may react.

Ok, now me... Few reminders about GVH disease:
most common in: bone marrow and liver transplants
cells involved: CD4+ and CD8+ cells
Triad of clinical findings:
Jaundice
Diarrhea
Dermatitis

After bone marrow transplantation: Host assumes donor ABO group
Danger of: GVH and CMV infection
Guys if you have some other useful info on GVH/bone marrow transplantation please add it in in the posts below
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