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Old 01-25-2013
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Question Story after bone marrow transplantation

A 51-year-old woman undergoes a successful bone marrow transplant from a matched unrelated donor for refractory Hodgkin’s disease. She is discharged from the hospital on no medications and is feeling well. At an appointment 6 months posttransplant she is well with no evidence of malignancy. Three weeks later she travels to Florida with her family. She is cautious of the sun but develops sunburn on her face, despite wearing sunscreen and a protective hat. When she returns from her trip 5 days later she presents with persistent erythema of her face. She also states her wrists and hands have been sore for the past 2–3 weeks. On examination her face is mildly tender to touch, and a rash is present. Her hands are diffusely swollen. She is afebrile, and the remainder of her physical examination is benign. What is the most likely diagnosis?

(A) Graft-versus-host disease
(B) Hypersensitivity to sunlight due to the patient’s antirejection regimen
(C) New-onset systemic lupus erythematosus
(D) Rosacea
(E) Staphylococcal skin infection acquired during travel
(F) Sun poisoning
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Old 01-25-2013
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i think b as none of the others seem to fit
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(C) New-onset systemic lupus erythematosus
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(C) New-onset systemic lupus erythematosus
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Old 01-25-2013
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I think C as well, The other choices just dont make sense and this seems like a polyarthropathy in which the other choices just dont make sense.
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Old 01-26-2013
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The correct answer is A. Twenty to 50% of patients with a history of allogeneic bone marrow transplant develop GVHD. GVHD is caused by a proliferation of grafted donor T lymphocytes that ultimately reject the host’s foreign proteins, leading to end-organ damage. This disease is a separate entity from acute GVHD and resembles an autoimmune disorder. It may result in macular-papular rash, as seen in this patient; sicca syndrome; arthritis; and bile duct degeneration, leading to jaundice. The chronic form of GVHD may occur months or even years after transplant and is likely due to vascular damage by the proliferated T lymphocytes. Patients who are >40 years at the time of transplant are at the greatest risk of developing chronic GVHD. This complication is irreversible,but prednisone is the standard of care.

Answer C is incorrect
. Although the patient certainly could be suffering from new-onset systemic lupus erythematous, in a patient with a history of bone marrow transplant, chronic GVHD is much more likely
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