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Doença do enxerto versus hospedeiro ocular : um caso clínico
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A doença do enxerto versus hospedeiro (DEVH) é uma entidade que constitui um dos principais obstáculos ao transplante alogénico de células estaminais (TACE), sendo responsável pelo aumento da morbilidade e mortalidade a este associadas.
A DEVH ocorre quando as células T transplantadas do dador reagem contra antigénios histoincompatíveis do recetor, gerando diversas lesões tecidulares, em locais e com gravidade variáveis, mais comumente na pele, no trato gastrointestinal e no fígado. Menos frequentemente também atingem os sistemas hematopoiéticos, urinário e ocular.
A nível ocular manifesta-se essencialmente por queratoconjuntivite sicca (QCS), devido a fibrose e disfunção das glândulas lacrimal e de Meibómius, que conduzem à alteração do filme lacrimal. O diagnóstico de DEVH ocular dá-se pela presença de QCS agravada e sintomática juntamente com manifestações distintivas de DEVH em outro órgão. Se estas manifestações clínicas não forem atempadamente notadas, podem gerar complicações, como a perfuração ocular evidenciada no caso clínico descrito.
A terapêutica local é baseada na lubrificação, diminuição da inflamação, prevenção da evaporação e drenagem. No entanto, esta nem sempre é suficiente, tendo de se recorrer à terapêutica sistémica e, por vezes, cirúrgica.
Pelas repercussões que esta patologia poderá ter na qualidade de vida destes pacientes, torna-se assim muito importante o seguimento oftalmológico precoce pós-TACE.
The graft versus host disease (GVHD) constitutes one of the main obstacles to the allogeneic stem cell transplantation (ASCT), increasing the morbidity and mortality associated to this procedure. GVHD occurs when the transplanted donor T cells react against histoincompatible recipient antigens, generating several tissue injuries in different places and with different clinical severity, affecting specially the skin, the gastrointestinal tract and the liver. Less frequently, it affects the haematopoietic, urinary and ocular systems. The main ocular manifestation is keratoconjunctivis sicca (KCS), due to the fibrosis of the lacrimal glands and dysfunction of Meibómius glands, which induce tear film modification. The diagnosis of ocular GVHD is made by the presence of KCS aggravated or symptomatic along with distinctive manifestations of GVHD in another organ. If this manifestations are not adequately noted, they can generate complications, such as the ocular perforation verified in the described case report. The local therapeutics is based on the ocular lubrication, decrease of the inflammatory process, evaporation prevention and drainage, although systemic or surgical interventions are sometimes needed. Because of the consequences which this pathology might have in the patient’s quality of life, the early ophthalmological monitoring becomes very important post-ASCT.
The graft versus host disease (GVHD) constitutes one of the main obstacles to the allogeneic stem cell transplantation (ASCT), increasing the morbidity and mortality associated to this procedure. GVHD occurs when the transplanted donor T cells react against histoincompatible recipient antigens, generating several tissue injuries in different places and with different clinical severity, affecting specially the skin, the gastrointestinal tract and the liver. Less frequently, it affects the haematopoietic, urinary and ocular systems. The main ocular manifestation is keratoconjunctivis sicca (KCS), due to the fibrosis of the lacrimal glands and dysfunction of Meibómius glands, which induce tear film modification. The diagnosis of ocular GVHD is made by the presence of KCS aggravated or symptomatic along with distinctive manifestations of GVHD in another organ. If this manifestations are not adequately noted, they can generate complications, such as the ocular perforation verified in the described case report. The local therapeutics is based on the ocular lubrication, decrease of the inflammatory process, evaporation prevention and drainage, although systemic or surgical interventions are sometimes needed. Because of the consequences which this pathology might have in the patient’s quality of life, the early ophthalmological monitoring becomes very important post-ASCT.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Doença enxerto-hospedeiro Transplante homólogo Células estaminais Linfócitos T Síndromes do olho seco Oftalmologia