A 55-year-old man with end-stage hepatitis C virus infection undergoes orthotopic liver transplantation from a deceased donor. The patient has no perioperative complications and is discharged from the hospital on appropriate immunosuppressant medications. One week after the surgery, he develops nausea, vomiting, abdominal pain, and bloody diarrhea. Physical examination shows a painful maculopapular rash over his neck, back, and extremities that extends to the palms and soles. Endoscopic evaluation reveals multiple ulcerations of the intestinal mucosa. Which of the following is the most likely cause of this patient's current condition?

Question

A 55-year-old man with end-stage hepatitis C virus infection undergoes orthotopic liver transplantation from a deceased donor.  The patient has no perioperative complications and is discharged from the hospital on appropriate immunosuppressant medications.  One week after the surgery, he develops nausea, vomiting, abdominal pain, and bloody diarrhea.  Physical examination shows a painful maculopapular rash over his neck, back, and extremities that extends to the palms and soles.  Endoscopic evaluation reveals multiple ulcerations of the intestinal mucosa.  Which of the following is the most likely cause of this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Graft-versus-host disease can occur following transplantation of organs rich in lymphocytes (eg, liver).  T lymphocytes found in the donor organ become sensitized against the MHC antigens of the recipient and subsequently attack the host's tissues.  The skin, liver, and gastrointestinal tract are most frequently affected.

A 55-Year-Old Man with End-Stage Hepatitis C Virus Infection Undergoes