Rejection, but in a Different Direction: Graft-Versus-Host Disease after Solid Organ Transplantation Mimicking an Infection

A 59-year-old man caucasian with hepatocellular carcinoma and liver cirrhosis due to hepatitis C underwent liver transplantation. Three months later he was admitted to the hospital due to voluminous diarrhea, nausea, and significant weakness. The patient was on immunosuppression with tacrolimus and mycophenolate mofetil, and never experienced transplanted organ rejection. Upon presentation, laboratory values showed a white blood cell count of 6.8 K/mcL, hemoglobin of 13.1 g/dL, platelet count of 207 K/mcL, creatinine of 1.99 mg/dL, aspartate aminotransferase of 22 units/L, alanine aminotransferase of 31 units/L, total bilirubin of 0.4 units/L, and an albumin of 2.7 g/dL.