Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Chronic GVHD manifesting as parotitis after allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 44, pages 821–822 (2009)Cite this article

GVHD is artificially divided into acute and chronic forms depending on its date of onset. Although there may be a continuum of clinical findings, chronic GVHD can affect numerous organs that are not typically affected by acute GVHD. Chronic GVHD involving the salivary glands and/or lacrymal glands, which clinically manifests as xerophthalmia and/or xerostomia similar to Sjögren's syndrome, occurs commonly after hematopoietic cells transplantation, particularly with transplants using mobilized PBSCs. However, de novo chronic GVHD manifesting as parotitis and submandibular lymphadenopathy is underrepresented in the literature. Here, we describe a patient with severe aplastic anemia, who received an allogeneic hematopoietic cell transplant that developed recurrent parotitis and submandibular lymphadenopathy >8 months after the procedure, which may have been a manifestation of chronic GVHD.

The patient is a 37-year-old Nepalese female, who developed RBC and plt transfusion-dependent pancytopenia in 2003. A BM biopsy was consistent with a diagnosis of severe aplastic anemia, and she received treatment in her homeland with prednisone and CYA for >2 years without response. She presented to the NHLBI in 2006 where a diagnosis of severe aplastic anemia was confirmed. She received a trial of CYA and horse antithymocyte globulin without response and subsequently underwent a T-cell replete G-CSF-mobilized PBSC transplant from her HLA identical sibling on 21 March 2007 after conditioning with fludarabine, CY (Cytoxan) and horse antithymocyte globulin.1 She received CYA and mini-dose MTX as GVHD prophylaxis. Neutrophil engraftment occurred on day +20 and by day +30 short tandem repeat-based PCR studies revealed that she had achieved 100% donor chimerism in myeloid and T-cell lineages. On day +85, she developed acute GVHD of the gastrointestinal tract associated with watery diarrhea, which resolved completely with corticosteroid therapy. On day +219, she developed new onset thrombocytopenia possibly related to chronic GVHD, which prompted treatment with mycophenolate mofetil (an evaluation for plt auto-antibodies was not pursued). On day +263, the patient was admitted to the hospital for evaluation of multiple new symptoms including symmetric, diffuse swelling of the neck and cheeks, facial edema, fever, a nonproductive cough and was noted to have increased blood eosinophils (18.2% with an absolute eosinophil count of 1.966 K cells/μl). Her medications on admission included CYA, mycophenolate mofetil, valtrex, atovaquone, amlodipine, magnesium and lamivudine. She had no earlier history of mumps or sick contact exposure.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Srinivasan R, Takahashi Y, McCoy JP, Espinoza-Delgado I, Dorrance C, Igarashi T et al. Overcoming graft rejection in heavily transfused and allo-immunised patients with bone marrow failure syndromes using fludarabine-based haematopoietic cell transplantation. Br J Haematol 2006; 133: 305–314.

    Article  CAS  PubMed  Google Scholar 

  2. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplantation 2005; 11: 945–955.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Drs Sumi Vasu, Steven Pavletic and Ram Srinivasan for their valuable input.

Author information

Authors and Affiliations

  1. National Institutes of Health/National Cancer Institute-National Heart, Lung, and Blood Institute (NIH/NCI-NHLBI), Bethesda, MD, USA

    D Z Drew, T Donohue, C Ramos, L Cook, R Goodwin, N Patronas, D Arrington, M Ramanathan & R Childs

Authors
  1. D Z Drew
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T Donohue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R Goodwin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. N Patronas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D Arrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M Ramanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R Childs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R Childs.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Drew, D., Donohue, T., Ramos, C. et al. Chronic GVHD manifesting as parotitis after allogeneic hematopoietic SCT. Bone Marrow Transplant 44, 821–822 (2009). https://doi.org/10.1038/bmt.2009.79

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.79

Search

Advanced search

Quick links