A Case of Chronic Graft-versus-Host Disease (GVHD) with Various Skin Lesions

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  • KAWAMOTO Michifumi
    Department of Anatomy, Biology and Medicine (Dermatology), Faculty of Medicine, Oita University
  • KAI Yoshitaka
    Department of Anatomy, Biology and Medicine (Dermatology), Faculty of Medicine, Oita University
  • ANZAI Saburo
    Department of Anatomy, Biology and Medicine (Dermatology), Faculty of Medicine, Oita University
  • HATANO Yutaka
    Department of Anatomy, Biology and Medicine (Dermatology), Faculty of Medicine, Oita University
  • KATAGIRI Kazumoto
    Department of Anatomy, Biology and Medicine (Dermatology), Faculty of Medicine, Oita University
  • FUJIWARA Sakuhei
    Department of Anatomy, Biology and Medicine (Dermatology), Faculty of Medicine, Oita University
  • OGATA Masao
    Department of Infectious Disease (2nd Internal Medicine), Faculty of Medicine, Oita University
  • KOHNO Kazuhiro
    Department of Infectious Disease (2nd Internal Medicine), Faculty of Medicine, Oita University
  • NASU Masaru
    Department of Infectious Disease (2nd Internal Medicine), Faculty of Medicine, Oita University

Bibliographic Information

Other Title
  • 多彩な皮膚病変を呈した慢性ＧＶＨＤの１例
  • 症例 多彩な皮膚病変を呈した慢性GVHDの1例
  • ショウレイ タサイナ ヒフ ビョウヘン オ テイシタ マンセイ GVHD ノ 1レイ

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Abstract

A 33-year-old man underwent allogeneic bone marrow transplantation from a non-blood relatives at the age of 31 years for chronic myelogenous leukemia. A sudden rise in transaminases was observed 40 days after transplantation and he was diagnosed as acute GVHD. Elevated hepatobiliary enzymes and pancytopenia continued, and acute GVHD shifted to chronic GVHD. Hestarted taking prednisolone and cyclosporin. Erythema and sclerosis appeared over his entire body 10 months after transplantation. Improvement of the skin lesions was not observed. He was hospitalized in our Department of Dermatology in July, 2003. There were few hairs, thick scales and crusts adhered to the head. Depigmentations and erosions with scales and blood crusts were observed on his face. Pigmentations and depigmentations existed widely on his body and limbs. On all fingers and toes, nail plates disappeared and digital flexions were limited. Several ulcers were observed on both heels and the lateral sides of the soles. The largest one was 5×3 cm. A biopsy specimen showed subepidermal blister, exocytosis, vacuolar alteration and necrotic keratinocytes. Lymphocytes infiltrated mildly in the upper dermis and densely around skin appendages in the middle and lower dermis. A direct immunofluorescencetest did not show a deposit of either C3 or IgM. Anemia, elevated hepatobiliary enzymes and CRP, and decreased immunoglobulin were observed. Antinuclear antibody was negative. He was treated with oral cyclosporin and prednisolone and an ointment of difluprednate and Azurene. Skin lesions improved by loading with cyclosporin. However cyclosporin was replaced by tacrolimus hydrate because of leucocytopenia and thrombocytopenia. Ulcers and erosions epithelialized except for the one on the right heel, which epithelialized very slowly in spite of restriction ofwalking and trying various kinds ofointments or dressing agents. The ulcer of the right heel reduced and epithelialized by use of trafermin in combination with tretinointocoferil. He left the hospital in November 2003 and five months after the discharge, the ulcer of the right heel epithelialized.

Journal

  • Nishi Nihon Hifuka

    Nishi Nihon Hifuka 70 (4), 381-386, 2008

    Western Division of Japanese Dermatological Association

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