Acute graft-versus-host disease (GVHD) is a rare but severe complication following solid organ transplantation.We present a case of fatal refractory GVHD-induced aplastic anemia in a 49-year-old female recipient of simultaneous pancreas and kidney transplantation.The GVHD was precipitated by an extensive donor-dominant one-way human leukocyte antigen (HLA) match at multiple loci (HLA-A, -B, -C, -DQB1, and -DRB1), contributing to its remarkable treatment resistance.Despite aggressive immunosuppressive therapies, including a cumulative dose of 16.5 mg/kg antithymocyte globulin, GVHD progressed to severe bone marrow failure resembling aplastic anemia, necessitating allogeneic hematopoietic stem cell transplantation.Although allogeneic hematopoietic stem cell transplantation was performed and neutrophil engraftment achieved, severe opportunistic infections ultimately led to the patient's death.These complications included an invasive fungal infection (candidemia and lung nodule) and, notably, herpes simplex virus (HSV) type-2 encephalitis.While invasive fungal infections are recognized life-threatening complications in heavily immunosuppressed hematopoietic stem cell transplant recipients, HSV-2 encephalitis is a particularly rare neurological complication in solid organ transplant recipients, especially its delayed onset or
Matsumura et al. (Thu,) studied this question.