The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 648-653, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Postoperative erythroderma after cardiac operations. The possible role of depressed cell-mediated immunity
K Hisatomi, T Isomura, A Hirano, H Yasunaga, T Sato, N Hayashida, K Ohishi and H Toshima
Second Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
Erythroderma as a manifestation of graft-versus-host disease after cardiac
operations with blood transfusion may occur more frequently in Japan than
in other countries. We have seen this problem in five patients who, after
heart operations, died with symptoms and signs characteristic of
graft-versus-host disease: cutaneous eruption, fever, diarrhea, leukopenia
associated with agranulocytosis, and liver dysfunction. In the three
patients seen most recently, skin biopsy showed findings similar to those
of graft-versus-host disease after bone marrow transplantation. In
addition, immunologic investigation showed remarkable differences in the
findings in these patients and in those who did not have a
graft-versus-host disease-like syndrome after cardiac operations. In
particular, interleukin-2 production in response to mitogen stimulation was
markedly diminished after operation in our patients, and the ratio of OKT4+
cells to OKT8+ cells in peripheral blood was low, reflecting increased
numbers of OKT8+ cells after the occurrence of symptoms. The results raise
the possibility that transient depression of cellular immunity after
cardiac operations with blood transfusion may contribute to the occurrence
of postoperative acute graft-versus-host disease.
