Vesicles in Chronic Graft-versus-host Disease / 대한피부과학회지

ABSTRACT

Chronic graft-versus-host disease (GVHD) usually presents 100 days after allogenic bone marrow transplantation. Chronic GVHD cutaneous lesions are characterized by lichenoid or sclerodermoid variants. Vesicles, a common presentation in patients with acute GVHD, rarely appear in chronic GVHD. We report a case of a 49-year-old man who presented with bilateral vesicles on lower extremities. He was diagnosed with myelodysplastic syndrome 2 years before and was taking oral cyclosporine after the allogenic bone marrow transplantation. Six months post-transplantation, lichenoid and sclerodermoid lesions developed on his entire body and he was diagnosed with chronic GVHD and eosinophilic fasciitis. A biopsy of the vesicles revealed detached lower margins of the epidermis, necrotized keratinocytes, and infiltration of lymphocytic inflammatory cells. Administration of oral prednisolone alleviated the patient's symptoms. This is an interesting case showing a new pattern of vesicle appearance after development of typical chronic GVHD lesions.