Editor,—Ahya et alreported a case of transfusion associated graft versus host disease (TA-GVHD) in a non-immunocompromised patient resulting from blood transfusion after coronary artery bypass grafting (CABG).1 They concluded that this devastating complication of transfusion is probably underreported. There is no doubt that diagnosing this condition needs a high index of suspicion because its manifestations can be seen in other more common conditions such as septicaemia. Moreover, histological diagnosis needs specialist expertise in tissue typing.

We report another patient with TA-GVHD acquired following elective four-vessel CABG and perioperative transfusion of a total of six units of blood. A 68 year old man was admitted three weeks after surgery with a seven day history of skin rash, breathlessness, cough, and expectoration of brown sputum. He had an extensive erythrodermic maculopapular eruption, oral thrush, tachycardia, hypotension, bilateral chest crepitations, and mild hepatomegaly. His condition worsened progressively …