Severe Desquamating Disorder After Liver Transplant: Toxic Epidermal Necrolyis or Graft Versus Host Disease?

Objective: The objective of this article is to present and discuss the clinical characteristics of TEN (Toxic Epidermal Necrolysis) and GVHD (Graft Versus Host Disease) following orthotopic liver transplantation. Methods: Recent experience with a patient who suffered a fatal desquamation syndrome within weeks of liver transplantation provides the basis for a discussion of differential diagnosis of these two conditions. Results: TEN and GVHD demonstrate similar clinical presentations as well as etiology (CD8+ lymphocyte attack on epithelial surfaces). This case demonstrates the difficulty in distinguishing between these two conditions in this particular patient. Conclusions: Advances in the understanding and treatment of one of these disease states may provide therapeutic insights into the other.