The Overlap Syndrome: A Case Report of Chronic Graft-Versus-Host Disease After the Development of a Pseudomembrane.
The Overlap Syndrome: A Case Report of Chronic Graft-Versus-Host Disease After the Development of a Pseudomembrane.
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DOI：
10.1097/ico.0000000000002593
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发表时间：
2021-09-01
期刊：
影响因子：
2.8
通讯作者：
Ogawa Y
中科院分区：
文献类型：
--
作者：
Hayashi S;Shimizu E;Uchino M;Yazu H;Aketa N;Tsubota K;Ogawa Y
眼移植物抗宿主病（GVHD）是造血干细胞移植最严重的并发症之一。它表现为眼表面的损伤，如严重的干眼病，并使接受者的视觉功能和生活质量恶化。我们遇到了一个“重叠综合征”的眼部移植物抗宿主病，其特点是存在急性和慢性移植物抗宿主病症状。本文报告一例眼部移植物抗宿主病合并重叠综合征的治疗进展。一位57岁男性急性髓细胞白血病患者接受造血干细胞移植。治疗6周后，接受者主诉眼痛和分泌物。他被诊断为重叠综合征，由于低泪液量，严重的角膜上皮，充血，和结膜上的假膜。假膜的病理改变为免疫细胞浸润、纤维素样变性、纤维母细胞和梭形细胞以及纤维化。受体接受局部免疫抑制和假膜去除治疗。初次治疗后一周，眼部GVHD改善。治疗12周后，由于眼内压升高，停用局部类固醇。眼GVHD中结膜假膜的评估对于确定病例的分期和评估全身GVHD具有重要意义。此外，诊断后及时去除假膜是减少眼部GVHD症状的适当管理。局部类固醇和免疫抑制剂的组合被认为是一种有效的治疗重叠综合征的管理。
Ocular graft-versus-host disease (GVHD) is one of the most severe complications of hematopoietic stem cell transplantation. It manifests as an impairment of the ocular surface, such as severe dry eye disease, and deteriorates the recipient's visual function and quality of life. We encountered an “overlap syndrome” of ocular GVHD, which is characterized by the presence of both acute and chronic GVHD symptoms. In this report, we present the treatment progress of the overlap syndrome in a case with ocular GVHD. A 57-year-old man with acute myeloblastic leukemia underwent hematopoietic stem cell transplantation. Six weeks after the treatment, the recipient complained of eye pain and discharge. He was diagnosed with the overlap syndrome due to low tear volume, severe corneal epithelitis, hyperemia, and a pseudomembrane on the conjunctiva. Immune cells infiltration, fibrinoid degeneration, fibroblastic and spindle-shaped cells, and fibrosis were observed in the pathology of the pseudomembrane. The recipient was treated with topical immunosuppression and pseudomembrane removal. One week after the initial treatment, ocular GVHD improved. Twelve weeks after the treatment, the topical steroid was discontinued due to the elevation of intraocular pressure. The assessment of conjunctival pseudomembrane in ocular GVHD is important to determine the stage of the case and to assess systemic GVHD. Furthermore, prompt removal of the pseudomembrane after diagnosis is an appropriate management to reduce the symptoms of ocular GVHD. The combination of topical steroids and immunosuppressive agents is suggested to be an effective treatment in management of overlap syndrome.