Simultaneous occurrence of gastric antral vascular ectasia and protein-losing enteropathy in chronic graft-versus-host disease

• Published in: International journal of hematology 2013-04, Vol.97 (4), p.529-534
• Main Authors: Hirayama, Masahiro, Azuma, Eiichi, Nakazawa, Atsuko, Iwamoto, Shotaro, Toyoda, Hidemi, Komada, Yoshihiro
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biopsy; Case Report; Child; Colon - pathology; Endoscopy, Gastrointestinal; Gastric Antral Vascular Ectasia - complications; Gastric Antral Vascular Ectasia - diagnosis; Gastric Antral Vascular Ectasia - drug therapy; Gastroenterology. Liver. Pancreas. Abdomen; Graft vs Host Disease - complications; Graft vs Host Disease - drug therapy; Graft vs Host Disease - etiology; Hematologic and hematopoietic diseases; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Immunosuppressive Agents - therapeutic use; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - diagnosis; Leukemia, Myeloid, Acute - therapy; Male; Medical sciences; Medicine; Medicine & Public Health; Oncology; Other diseases. Semiology; Protein-Losing Enteropathies - complications; Protein-Losing Enteropathies - diagnosis; Protein-Losing Enteropathies - drug therapy; Serum Albumin - metabolism; Stomach - pathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Outcome
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-013-1279-y

Gastric antral vascular ectasia (GAVE) leading to upper gastrointestinal bleeding is a heterogeneous disorder that is not commonly recognized in hematopoietic stem cell transplantation (HSCT). Protein-losing enteropathy (PLE) is noted as another gastrointestinal complication in the context of chronic graft-versus-host disease (GVHD) after HSCT. The possibility of a relationship between these two distinct gastrointestinal disorders, however, remains obscure. A 6-year-old boy with acute myelogenous leukemia developed severe hematemesis 4 months after myeloablative HSCT from a human leukocyte antigen-matched sibling donor. The diagnosis of GAVE was made by upper endoscopy and histological examination. The patient simultaneously developed frequent diarrhea and significant hypoproteinemia, consistent with a diagnosis of PLE. This co-occurrence of GAVE and PLE against a background of chronic GVHD was successfully treated with cyclosporin A and prednisolone. To our knowledge, this is the first report of GAVE concurrent with PLE following HSCT. The possible association of GAVE and PLE in chronic GVHD is discussed.