A 45 year old man received an allogeneic bone marrow transplant for Acute Lymphatic Leukaemia. 26 days after the transplant the patient developed severe gastroenteritis and a maculopapular skin rash and respiratory insufficiency.
The following investigations were performed:
|
Hb |
94 G/L |
(110-150 |
Na (mmol/L) |
132 |
135-145 |
|
|
WCC |
2.3 x 109/L |
(4.0-10.0) |
K ( mmol/L) |
3.4 |
3.5-.5.0 |
|
|
Platelets |
54 x 109/L |
(150-300) |
Urea (mmol/L) |
8.2 |
4.0-6.0 |
|
|
Creatinine (mmol/L) |
0.1 |
0.04-0.12 |
||||
|
Bilirubin (micromol/L) |
67 |
<25 |
||||
|
Alkaline phosphatase |
265 |
<125 |
||||
|
ALT |
51 |
<40 |
||||
|
AST |
40 |
<40 |
Coagulation profile - normal
Stool: Microscopy: WCC ++ Cultures: No growth
C.difficile toxin- Not detected
a) List 3 possible diagnoses.
Over the next 3 weeks, the patient developed generalized oedema predominantly in the trunk and lower extremities. An ultrasound Doppler study of the abdomen revealed dilated portal vein and inferior vena cava. The right atrial pressures were normal.
Portal pressure 18 mm Hg (8 – 10)
Infrahepatic IVC 20 mm Hg (9-11)
Hepatic vein 8 mm Hg (9-10)
Suprahepatic IVC 8 mm Hg (7-8)
Right atrium 6 mm Hg
b) What is the likely explanation for these findings?
c) Name 2 treatment measures for the diagnosis in b)
a) List 3 possible diagnoses.
Sepsis CMV GVH
b) What is the likely explanation for these findings?
Veno-occlusive disease of the liver
c) Name 2 treatment measures for the diagnosis in b)
TIPS procedure
Diuretics
Fluid restriction
This question closely resembles Question 26.2 from the first paper of 2013.