Exocrine pancreatic insufficiency and graft-versus-host disease.
Julia López CardonaCarla Senosiaín LalastraFrancisco Mesonero GismeroIrene García de la Filia MolinaSergio Escribano CruzGonzalo Trigo GallegoAgustín Albillos MartínezPublished in: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva (2022)
We present the case of a 59-year-old man with acute myeloid leukemia treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Two years later, he consulted for diarrhea and steatorrhea of 2-3 months of evolution with significant weight loss. Stool cultures and study of parasites were negative. Thyroid and celiac profile, cytomegalovirus viremia and colonoscopy, were normal. Fecal calprotectin and fecal clearance of alpha-1-Antitrypsin were normal but with almost undetectable fecal elastase (<15 ug/g). Pancreatic magnetic resonance reveals a generalized atrophy of the pancreas without other parenchymal or ductal alterations. The patient had no risk factors for chronic pancreatitis and was diagnosed with exocrine pancreatic insufficiency (EPI) associated with chronic graft-versus-host disease (GVHD). GVHD is caused by an immune-mediated reaction by donor T cells recognizing foreign antigens from the recipient. GVHD occurs in 80% of patients after allo-HSCT. Diarrhea is one of the most frequent manifestations, most often due to intestinal damage, opportunistic infections or chemoradiation effects.
Keyphrases
- allogeneic hematopoietic stem cell transplantation
- acute myeloid leukemia
- acute lymphoblastic leukemia
- magnetic resonance
- weight loss
- end stage renal disease
- newly diagnosed
- ejection fraction
- chronic kidney disease
- bariatric surgery
- case report
- prognostic factors
- epstein barr virus
- irritable bowel syndrome
- type diabetes
- locally advanced
- squamous cell carcinoma
- hematopoietic stem cell
- immune response
- magnetic resonance imaging
- patient reported outcomes
- body mass index
- patient reported
- computed tomography
- diffuse large b cell lymphoma
- insulin resistance