SECONDARY BILIARY-CIRRHOSIS AS A CONSEQUENCE OF GRAFT-VERSUS-HOST DISEASE

A 9-yr-old white girl with acute monoblastic leukemia received an HLA-identical, mixed lymphocyte culture-nonreactive bone marrow transplant from her sister. Twelve days after the transplant, a diffuse, pruritic, maculopapular rash involving the entire body surface (including the palms and soles) developed. Subsequent skin biopsy was consistent with cutaneous graft-versus-host disease, and biopsyproven hepatic involvement manifested by severe, unremitting cholestatic jaundice soon followed. The patient's biliary status as monitored by serial liver biopsies demonstrated progression from chronic graftversus-host disease to cirrhosis, culminating in death secondary to liver failure 25 mo after transplant. © 1990.