Abstract
The cutaneous manifestations of graft-versus-host disease (GVHD) are protean and often diagnostically challenging. Acute GVHD (aGVHD) of the skin most often presents with a morbilliform exanthem, which may progress to generalized erythema and bullae in severe cases, bearing striking resemblance to toxic epidermal necrolysis. The manifestations of chronic GVHD (cGVHD) are more diverse and often resemble other dermatologic conditions. For example, diagnostic signs of cGVHD, based on the NIH Consensus Criteria, include poikiloderma, lichen planus-like features, sclerotic features, morphea-like features, and lichen sclerosus-like features [1]. More atypical presentations of cutaneous GVHD also often mimic other disorders, in which case histologic findings supportive of GVHD can help establish the diagnosis. This chapter highlights the many atypical and under-recognized manifestations of both acute and chronic cutaneous GVHD (Table 12.1).
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References
Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant. 2015;21(3):389–401.e1.
Kuskonmaz B, Gucer S, Boztepe G, Cetin M, Uckan D. Atypical skin graft-vs.-host disease following bone marrow transplantation in an infant. Pediatr Transplant. 2007;11(2):214–6.
Cornejo CM, Kim EJ, Rosenbach M, Micheletti RG. Atypical manifestations of graft-versus-host disease. J Am Acad Dermatol. 2015;72(4):690–5.
Hymes SR, Turner ML, Champlin RE, Couriel DR. Cutaneous manifestations of chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2006;12(11):1101–13.
Hymes SR, Alousi AM, Cowen EW. Graft-versus-host disease: part I. Pathogenesis and clinical manifestations of graft-versus-host disease. J Am Acad Dermatol. 2012;66(4):515.e1–515.e18.
Wei J, Zhang Y, Xu H, Jin J, Zhang J. Atopic dermatitis-like presentation of graft-versus-host disease: a novel form of chronic cutaneous graft-versus-host disease. J Am Acad Dermatol. 2013;69(1):34–9.
Cohen EW. Graft-versus-host disease. In: Bolognia JL, Jorizzo JL, Scaffer JV, editors. Dermatology. 3rd ed. New York: Elsevier; 2012. p. 755.
Creamer D, Martyn-Simmons CL, Osborne G, Kenyon M, Salisbury JR, Devereux S, et al. Eczematoid graft-vs-host disease: a novel form of chronic cutaneous graft-vs-host disease and its response to psoralen UV-A therapy. Arch Dermatol. 2007;143(9):1157–62.
Taguchi S, Kawachi Y, Fujisawa Y, Nakamura Y, Furuta J, Otsuka F. Psoriasiform eruption associated with graft-versus-host disease. Cutis. 2013;92(3):151–3.
Matsushita T, Hasegawa M, Shirasaki F, Fujimoto M, Yamazaki H, Sato S, et al. A case of acute cutaneous graft-versus-host disease mimicking psoriasis vulgaris. Dermatology. 2008;216(1):64–7.
Kawakami Y, Oyama N, Nakamura K, Kaneko F, Kikuta A, Suzuki H. Psoriasiform eruption associated with graft-versus-host disease. Acta Derm Venereol. 2007;87(5):436–8.
Kim SJ, Choi JM, Kim JE, Cho BK, Kim DW, Park HJ. Clinicopathologic characteristics of cutaneous chronic graft-versus-host diseases: a retrospective study in Korean patients. Int J Dermatol. 2010;49(12):1386–92.
Surjana D, Robertson I, Kennedy G, James D, Weedon D. Acute cutaneous graft-versus-host disease resembling type II (atypical adult) pityriasis rubra pilaris. Australas J Dermatol. 2013;56(1):e21–3.
Spelman LJ, Robertson IM, Strutton GM, Weedon D. Pityriasis rosea-like eruption after bone marrow transplantation. J Am Acad Dermatol. 1994;31(2 Pt 2):348–51.
Chao SC, Tsao CJ, Liu CL, Lee JY. Acute cutaneous graft-versus-host disease with ichthyosiform features. Br J Dermatol. 1998;139(3):553–5.
Huang J, Pol-Rodriguez M, Silvers D, Garzon MC. Acquired ichthyosis as a manifestation of acute cutaneous graft-versus-host disease. Pediatr Dermatol. 2007;24(1):49–52.
Doherty C, Ulitsky O, Petronic-Rosic V. Erythema multiforme-like presentation of chronic graft versus host disease. J Am Acad Dermatol. 2008;59(5 Suppl):S127–8.
Friedman KJ, LeBoit PE, Farmer ER. Acute follicular graft-vs-host reaction. A distinct clinicopathologic presentation. Arch Dermatol. 1988;124(5):688–91.
Lycka BA, Kaye VN. Acute follicular graft-vs-host disease. Arch Dermatol. 1988;124(9):1442.
Tani M, Adachi A. Acute follicular graft-versus-host disease. Dermatology. 1992;185(4):281–3.
Ahn HS, Park HJ, Lee JY, Cho BK. A case of chronic cutaneous graft versus host disease with the clinical features of exfoliative dermatitis. Ann Dermatol. 2009;21(3):319–22.
Nambudiri VE, Tsiaras WG, Schmidt BA, Huang JT. Total leukoderma and leukotrichia in a child after hematopoietic SCT: report of a case and review of the literature. Bone Marrow Transplant. 2014;49(3):460–2.
Marti N, Martin JM, Monteagudo C, Lopez V, Jorda E. Follicular graft-versus-host disease: a rare manifestation of chronic cutaneous graft-versus-host disease. Am J Dermatopathol. 2008;30(6):620–1.
Valks R, Vargas E, Fraga J, Penas PF, Fernandez-Herrera J. A follicular lichenoid eruption as manifestation of chronic graft-vs-host disease. Acta Derm Venereol. 1998;78(5):386.
Miyazaki K, Higaki S, Maruyama T, Takahashi S, Morohashi M, Ito K. Chronic graft-versus-host disease with follicular involvement. J Dermatol. 1993;20(4):242–6.
Llamas-Velasco M, Solano-López Morel GE, Gruber-Wackernagel A, Concha-Garzón MJ, Requena L, Cerroni L. Comedonal graft-vs-host disease: a distinct clinical expression of a lichenoid follicular GVHD. J Cutan Pathol. 2014;41(11):853–8.
Chow RKP, Steward WD, Ho VC. Graft-versus-host reaction affecting lesional skin but not normal skin in a patient with piebaldism. Br J Dermatol. 1996;134(1):134–7.
Kossard S, Ma DD. Acral keratotic graft versus host disease simulating warts. Australas J Dermatol. 1999;40(3):161–3.
Adamski H, Le Gall F, Cartron L, Dauriac C, Lancien G, Wechsler J, et al. Eruptive angiomatous lesions associated with graft-versus-host disease. Br J Dermatol. 2003;149(3):667–8.
Kaffenberger BH, Zuo RC, Gru A, Plotner AN, Sweeney SA, Devine SM, et al. Graft-versus-host disease-associated angiomatosis: a clinicopathologically distinct entity. J Am Acad Dermatol. 2014;71(4):745–53.
Garnis S, Billick RC, Srolovitz H. Eruptive vascular tumors associated with chronic graft-versus-host disease. J Am Acad Dermatol. 1984;10(5 Pt 2):918–21.
Barnadas MA, Brunet S, Sureda A, López R, Curell R, Sierra J, et al. Exuberant granulation tissue associated with chronic graft-versus-host disease after transplantation of peripheral blood progenitor cells. J Am Acad Dermatol. 1999;41(5 Suppl):876–9.
Soo JK, Mortimer PS. Eruptive angiomas associated with graft-versus-host disease. Br J Dermatol. 2006;154(2):376–8.
Hu SW, Myskowski PL, Papadopoulos EB, Busam KJ. Chronic cutaneous graft-versus-host disease simulating hypertrophic lupus erythematosus-a case report of a new morphologic variant of graft-versus-host disease. Am J Dermatopathol. 2012;34(6):e81–3.
Goiriz R, Penas PF, Delgado-Jimenez Y, Fernandez-Herrera J, Aragues-Montanes M, Fraga J, et al. Cutaneous lichenoid graft-versus-host disease mimicking lupus erythematosus. Lupus. 2008;17(6):591–5.
Ollivier I, Wolkenstein P, Gherardi R, Wechsler J, Kuentz M, Cosnes A, et al. Dermatomyositis-like graft-versus-host disease. Br J Dermatol. 1998;138(3):558–9.
Vassallo C, Derlino F, Ripamonti F, Borroni G. Lichenoid cutaneous chronic GVHD following Blaschko lines. Int J Dermatol. 2014;53(4):473–5.
Beers B, Kalish RS, Kaye VN, Dahl MV. Unilateral linear lichenoid eruption after bone marrow transplantation: an unmasking of tolerance to an abnormal keratinocyte clone? J Am Acad Dermatol. 1993;28(5 Pt 2):888–92.
Cohen PR, Hymes SR. Linear and dermatomal cutaneous graft-versus-host disease. South Med J. 1994;87(7):758–61.
Freemer CS, Farmer ER, Corio RL, Altomonte VL, Wagner JE, Vogelsang GB, et al. Lichenoid chronic graft-vs-host disease occurring in a dermatomal distribution. Arch Dermatol. 1994;130(1):70–2.
Lee SW, Kim YC, Lee E, Kang HY. Linear lichenoid graft versus host disease: an unsual configuration following Blaschko’s lines. J Dermatol. 2006;33(8):583–4.
Kennedy FE, Hilari H, Ferrer B, Garcia-Patos V. Lichenoid chronic graft-vs-host disease following Blaschko lines. Actas Dermosifiliogr. 2014;105(1):89–92.
Kikuchi A, Okamoto S, Takahashi S, Asano S, Nishikawa T. Linear chronic cutaneous graft-versus-host disease. J Am Acad Dermatol. 1997;37(6):1004–6.
Wilson BB, Lockman DW. Linear lichenoid graft-vs-host disease. Arch Dermatol. 1994;130(9):1206–8.
Anli H, Anadolu R, Arat M, Ekmekci P, Birol A, Erdem C, et al. Dermatomal lichenoid graft-versus-host disease within herpes zoster scars. Int J Dermatol. 2003;42(7):562–4.
Martires KJ, Baird K, Citrin DE, Hakim FT, Pavletic SZ, Cowen EW. Localization of sclerotic-type chronic graft-vs-host disease to sites of skin injury: potential insight into the mechanism of isomorphic and isotopic responses. Arch Dermatol. 2011;147(9):1081–6.
White JML, Creamer D, Du Vivier AWP, Pagliuca A, Ho AY, Devereux S, et al. Sclerodermatous graft-versus-host disease: clinical spectrum and therapeutic challenges. Br J Dermatol. 2007;156(5):1032–8.
Baselga E, Drolet BA, Segura AD, Leonardi CL, Esterly NB. Dermatomal lichenoid chronic graft-vs-host disease following varicella-zoster infection despite absence of viral genome. J Cutan Pathol. 1996;23(6):576–81.
Lacour JP, Sirvent N, Monpoux F, Perrin C, Castanet J, Michel G, et al. Dermatotmal chronic cutaneous graft-versus-host disease at the site of prior herpes zoster. Br J Dermatol. 1999;141(3):587–9.
Cordoba S, Fraga J, Bartolome B, Garcia-Diez A, Fernandez-Herrera J. Giant cell lichenoid dermatitis within herpes zoster scars in a bone marrow recipient. J Cutan Pathol. 2000;27(5):255–7.
Hymes SR, Hood AF, Farmer ER. Graft-versus-host disease. In: Jordan RE, editor. East Norwalk: Appleton & Lange; 1991. p. 509–23.
Palacios-Alvarez I, Santos-Briz A, Jorge-Finnigan C, Cañueto J, Fernandez-López E, Roman-Curto C. Chronic cutaneous lichenoid graft-versus-host disease at the area of herpes zoster infection and at a vaccination site. Br J Dermatol. 2015;173(4):1050–3.
Reisfeld PL. Lichenoid chronic graft-vs-host disease. Arch Dermatol. 1994;130(9):1207.
Chosidow O, Bagot M, Vernant JP, Roujeau JC, Cordonnier C, Kuentz M, et al. Sclerodermatous chronic graft-versus-host disease. Analysis of seven cases. J Am Acad Dermatol. 1992;26(1):49–55.
Mehra T, Metzler G, Bauer J, Koberle M, Garbe C. Isotopic response of graft versus host disease following herpes zoster infection: case report and review of the literature. Acta Derm Venereol. 2012;92(4):383–4.
Raymond AK, Singletary HL, Nelson K, Sidhu-Malik NK. Dermatomal sclerodermoid graft-vs-host disease following varicella-zoster virus infection. Arch Dermatol. 2011;147(9):1122–3.
Fenyk JRJ, Smith CM, Warkentin PI, Krivit W, Goltz RW, Neely JE, et al. Sclerodermatous graft-versus-host disease limited to an area of measles exanthem. Lancet. 1978;1(8062):472–3.
Alexander LJ, Paravar T, Duvic M, Prieto V, Hymes SR. Annular plaques: an unusual manifestation of graft-versus-host disease. Dermatol Online J. 2012;18(6):4.
Patel AR, Pavletic SZ, Turner ML, Cowen EW. The isomorphic response in morphealike chronic graft-vs-host disease. Arch Dermatol. 2008;144(9):1229–31.
Schaffer JV, McNiff JM, Seropian S, Cooper DL, Bolognia JL. Lichen sclerosus and eosinophilic fasciitis as manifestations of chronic graft-versus-host disease: expanding the sclerodermoid spectrum. J Am Acad Dermatol. 2005;53(4):591–601.
White JML, Devereux S, Pagliuca A, Salisbury JR, Du Vivier AWP, Creamer D. Koebnerizing sclerodermatous graft-versus-host disease caused by donor lymphocyte infusion and interferon? Br J Dermatol. 2006;155(3):621–3.
Girault PY, Waton J, Barbaud A, Bordigoni P, Schmutz JL. Isomorphic disposition of chronic graft-versus-host disease in striae distensae. J Eur Acad Dermatol Venereol. 2009;23(5):574–5.
Okamoto S, Takahashi S, Inoue T, Tojo A, Tani K, Kikuchi A, et al. Cutaneous chronic graft-versus-host disease localized to the field of total lymphoid irradiation. Bone Marrow Transplant. 1996;17(1):111–3.
Socie G, Gluckman E, Cosset JM, Devergie A, Girinski T, Esperou H, et al. Unusual localization of cutaneous chronic graft-versus-host disease in the radiation fields in four cases. Bone Marrow Transplant. 1989;4(1):133–5.
Zwaan FE, Jansen J, Noordijk EM. Graft-versus-host disease limited to an area of irradiated skin. Lancet. 1980;315(8177):1081–2.
Vassallo C, Brazzelli V, Zecca M, Locatelli F, Alessandrino P, Borroni G. Isomorphic cutaneous graft-versus-host disease reaction after ultraviolet exposure: clinical, histological and direct immunofluorescence studies of four allo-transplanted patients. J Eur Acad Dermatol Venereol. 2009;23(8):913–8.
Nagler A, Goldenhersh MA, Levi-Schaffer F, Bystryn JC, Klaus SN. Total leucoderma: a rare manifestation of cutaneous chronic graft-versus-host disease. Br J Dermatol. 1996;134(4):780–3.
Jacobsohn DA, Ruble K, Moresi JM, Vogelsang GB. Rapid-onset leucoderma associated with graft-versus-host disease. Bone Marrow Transplant. 2002;30(10):705–6.
Man J, Kalisiak M, Birchall IW, Salopek TG. Chronic cutaneous graft-versus-host disease manifesting as calcinosis cutis universalis on a background of widespread sclerodermatoid changes. J Cutan Med Surg. 2010;14(5):249–53.
Hymes S, Farmer ER, Burns WH, Morison WL, Tutschka PJ, Walters LL, et al. Bullous sclerodermalike changes in chronic graft-vs-host disease. Arch Dermatol. 1985;121:1189–92.
Jachiet M, de Masson A, Peffault de Latour R, Rybojad M, Robin M, Bourhis J, et al. Skin ulcers related to chronic graft-versus-host disease: clinical findings and associated morbidity. Br J Dermatol. 2014;171(1):63–8.
Ammer J, Prantl L, Holler B, Landfried K, Wolff D, Karrer S, et al. Successful treatment of a refractory skin ulcer in chronic cutaneous GvHD after allogeneic HSCT with split-thickness skin allografting from the stem cell donor. Bone Marrow Transplant. 2012;47(10):1368–9.
Knobler HY, Sagher U, Peled IJ, Wexler MR, Steiner D, Rubinstein N, et al. Tolerance to donor-type skin in the recipient of a bone marrow allograft. Treatment of skin ulcers in chronic graft-versus-host disease with skin grafts from the bone marrow donor. Transplantation. 1985;40(2):223–5.
Kondo S, Tamura K, Makino S, Takamatsu Y. Allogeneic skin grafting for extensive skin chronic graft-versus-host disease. Int J Hematol. 1994;60(2):151–5.
Kamei Y, Torii S, Hasegawa M, Toriyama K, Kodera Y. Simultaneous allografting and autografting of skin for ulcers in a bone marrow transplant patient. Transplantation. 1993;56(6):1530–1.
Berg JO, Vindelov L, Schmidt G, Drzewiecki KT. Allogeneic split-skin grafting in stem cell transplanted patients. J Plast Reconstr Aesthet Surg. 2008;61(12):1512–5.
Caffee HH, Miller TA. Skin rejection in graft-versus-host disease. Plast Reconstr Surg. 1978;61(5):753–5.
Crocchiolo R, Nicolini FE, Sobh M, Ducastelle-Lepretre S, Labussiere H, Dubois V, et al. Treatment of a severe extensive cutaneous chronic GVHD after allo-HSCT using glycerolyzed skin allografts and cultured epidermis from the same donor. Bone Marrow Transplant. 2011;46(8):1153–5.
Storb R, Thomas ED, Buckner CD, Clift RA, Fefer A, Fernando LP, et al. Allogeneic marrow grafting for treatment of aplastic anemia: a follow-up on long-term survivors. Blood. 1976;48(4):485–90.
Cook-Norris RHWR. Eczematoid graft-vs-host disease. Arch Dermatol. 2008;144(8):1066.
Schauder CS, Hymes SR, Rapini RP, Zipf TF. Vesicular graft-versus-host disease. Int J Dermatol. 1992;31(7):509–10.
Arin MJ, Scheid C, Hübel K, Krieg T, Groth W, Haerrmann G. Chronic graft-versus-host disease with skin signs suggestive of dermatomyositis. Clin Exp Dermatol. 2006;31(1):141–3.
Kawano N, Gondo H, Kamimura T, Aoki K, Iino T, Ishikawa F, et al. Chronic graft-versus-host disease following varicella-zoster virus infection in allogeneic stem cell transplant recipients. Int J Hematol. 2003;78(4):370–3.
Korth J, Tischer J, Samtleben W, Weiss C, Ruzicka T, Wollenberg A. Isotopic response, Köbner phenomenon and Renbök phenomenon following herpes zoster. J Dermatol. 2011;38(11):1058–61.
Ruocco V, Brunetti G, Puca R, Ruocco E. The immunocompromised district: a unifying concept for lymphoedematous, herpes-infected and otherwise damaged sites. J Eur Acad Dermatol Venereol. 2009;23(12):1364–73.
Akay BN, Sanli H, Topcuoglu P, Zincircioglu G, Gurgan C, Heper AO. Black hairy tongue after allogeneic stem cell transplantation: an unrecognized cutaneous presentation of graft-versus-host disease. Transplant Proc. 2010;42(10):4603–7.
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Cornejo, C.M., Micheletti, R.G. (2017). Atypical Manifestations of Graft-Versus-Host Disease. In: Cotliar, J. (eds) Atlas of Graft-versus-Host Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-46952-2_12
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