Severe Acute Cellular Rejection:
30 year-old male with history of non ischemic
cardiomyopathy developed severe systolic heart failure
and received an orthotopic heart transplant.
of the myocardial tissue performed at one month after
the transplant showed myocardial tissue with diffuse and severe
polymorphous mononuclear infiltrates with extensive
myocyte damage, interstitial edema, vasculitis and focal
necrosis (H&E staining in Figures A, C & E, and
corresponding trichrome stains in Figures B, D & F). Special immunohistochemistry
(IHC) stain for CD4 in a consecutive section from E and
F (Figure G) shows a predominant infiltrate for helper
cells. All these features are consistent with
severe acute cellular rejection, ISHLT 2004 Grade 3R (ISHLT
1990 Grade 3B).
May 22, 2018