Case series of cutaneous graft-versus-host disease (GVHD) in patients receiving haematopoietic stem cell transplantation in a tertiary Malaysian hospital
Document Type
Article
Publication Date
1-1-2023
Abstract
Introduction: Acute and chronic graft-versus-host disease (GVHD) are multisystem disorders which are complications of haematopoietic stem cell transplant (HSCT). It is important to consider other differential diagnoses that may have similar clinical and histopathologic features as GVHD. Method: A retrospective analysis was conducted on adult patients from a single centre who developed GVHD after HSCT between January 2014 and June 2018. Results: Fourteen patients were included where 13 had acute GVHD and 1 had chronic GVHD. The median age was 35.0 years (IQR 26 to 44 years) while median onset of cutaneous symptoms for acute GVHD was 70 days (IQR 17.0 - 96.5 days). All cases had histopathological confirmation. For acute GVHD (n=13), classical presentation with generalised exanthem and perifollicular erythema is the commonest (84.6%, n=11), where 61.5% and 38.5% of patients had stage 2 and 3 extent of skin involvement, respectively (n=8, n=5). 76.9% (n=10) of patients with acute GVHD had other organs involvement, such as liver, eyes, and gut. Lerner's grade 2 was the most common histological grade for patients with acute GVHD (53.8%, n=7) followed by grade 1 (38.5%, n=5). One patient with chronic GVHD had lichen planus-like presentation. All patients had received various antibiotics within two months prior to onset. None of the skin biopsies showed significant eosinophilic infiltrates. Conclusion: Cutaneous manifestations of GVHD are among the earliest presenting complaints among patients who have undergone HSCT. Half of these patients only had skin GVHD without any other organs involvement. Hence, biopsy is important to confirm the diagnosis of GVHD along with clinical correlation.
Keywords
Graft versus host disease, Haematopoietic stem cell transplant, Histopathology of GVHD, Skin biopsy for GVHD
Divisions
medicinedept,pathology
Publication Title
Hong Kong Journal of Dermatology and Venereology
Volume
31
Issue
1
Publisher
Medcom Limited
Publisher Location
ROOM 504-5, CHEUNG TAT CENTRE, 18 CHEUNG LEE ST, CHAI WAN, HONG KONG 00000, PEOPLES R CHINA