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A chronic myeloid leukaemia was diagnosed in a 25 year old woman, and nine months later she developed an acute transformation. After conditioning chemotherapy without total body irradiation, she received an allogenic bone marrow transplantation (BMT). Post transplant complications included pulmonary infections and acute graft versus host disease (GVHD) affecting the skin (grade I) and the liver, with a rapid response to corticosteroids and cyclosporin. In the following year, she developed diabetes, cataract, and femoral osteonecrosis, and the treatment was tapered. Chronic diarrhoea progressively developed with weight loss of 20 kg. Stool weight was of 600 g/day with steatorrhoea of 45 g/day. The d-xylose test was normal and the Schilling test showed partial B12 malabsorption. Oesogastroduodenoscopy with biopsies was normal. Ileocolonoscopy was macroscopically normal but biopsies of the ileum showed signs of attenuated GVHD. A computed tomography scan of the abdomen was performed (fig 1B) and compared with a previous scan, performed before BMT (fig 1A).
What do theses scans (fig 1A, B) show?
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This case is submitted by:
Robin Spiller, Editor