Pericardial Constriction Attributable to Graft-Versus-Host Disease

Abstract

Graft-versus-host disease (GVHD) occurs as a complication of hematopoietic stem cell transplantation when donor immune cells attack host cells identified as immunologically nonself. This is beneficial in completing the eradication of residual malignant cells (the graft versus tumor effect), but detrimental through attack on other host cells and subsequent manifestations of acute and chronic GVHD. Cardiac manifestations of GVHD are rare and include pericardial effusion, coronary artery disease, and conduction abnormalities.1 There are only 2 previously described cases of GVHD-induced pericardial constriction.2,3 Here, we report a case of hematopoietic stem cell transplantation complicated by constrictive pericarditis associated with chronic GVHD of the pericardium, which showed rapid response to systemic corticosteroids. A 44-year-old information technology consultant and keen long-distance cyclist was referred to the cardiac clinic for investigation of dyspnoea. He was diagnosed 4 years previously with Philadelphia-positive acute lymphoblastic leukemia, and was refractory to induction chemotherapy, later achieving morphological remission with imatinib and Ida-FLAG (idarubicin, fludarabine, cytarabine, and granulocyte colony–stimulating factor). He went on to have hematopoietic stem cell transplantation with a regime involving full intensity myeloablation and total body irradiation, followed by infusion of matched unrelated donor hematopoietic stem cells. He made a good initial recovery, complicated only a pleural effusion managed …