Graft-versus-host disease: its oral manifestations

[摘要] Graft-versus-hostdisease is the main complication following an allogeneic tissue transplant.It is caused by an exaggerated inflammatory reaction mediated by donor lymphocytesand stimulated by tissues lesioned by the underlying disease, by previous infectionor by the conditioning treatment. The diagnosis is clinical and histopathological.Patients have itchy and painful maculopapular rash that can spread throughoutthe entire body surface, fever, vomiting, nausea, diarrhea and anorexia. Extremelypainful ulcerated erosions occur in the oral mucosa, which may be the firstor the only clinically detectable manifestation of the disease. The objectiveis to report a case of graft-versus-host disease. A 54 year-old woman with non-Hodgkinlymphoma was treated with chemotherapy, radiation therapy and hematopoieticcell transplantation in 2009. After three months, she presented skin lesionsdiagnosed as graft-versus-host disease and received corticosteroids. Six monthslater, she was referred to the dentist because of complaints of xerostomia,a burning sensation in her mouth and difficulty chewing. She also had ulcersin the oral mucosa and tongue. This time she received topical corticosteroidtherapy, chlorhexidine, oral hygiene instructions and permanent clinical control.Despite some protocols for the prevention and treatment of graft-versus-hostdisease, its frequency has recently risen due to the increasing number of transplants.For this reason, it is essential for the dentist to be part of the multidisciplinaryteam treating the patient, and familiar with the signs and symptoms of the disease,since clinical manifestations may be the only ones at hand to make the diagnosis.

[学科分类] 基础医学

[关键词] graft-versus-host disease;rejection disease;graft-host reaction.