Department of Dermatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia.
J Cutan Pathol. 2020 Nov;47(11):1085-1095. doi: 10.1111/cup.13836. Epub 2020 Aug 28.
Graft-vs-host disease (GVHD) is the most common complication following hematopoietic cell transplantation, which affects skin frequently. Acute and chronic forms of GVHD manifest commonly as maculopapular to morbilliform eruptions and sclerotic or lichen-planus-like lesions, respectively; however, atypical presentations such as eczema-like GVHD may occur at times. We describe three cases of GVHD with diverse and polymorphous cutaneous eruptions including pompholyx-like and vasculitis-like rash as well as erythematous plaques and papulosquamous eruptions, with skin biopsy showing unifying histopathological findings with concurrent changes of spongiotic dermatitis and vacuolar interface reaction with apoptotic keratinocytes. In addition, the clinical and pathological features of previously reported cases of eczema-like GVHD are reviewed. It is emphasized that the course of the disease can be variable and successful management often involves a combination of multiple therapeutic modalities including immunosuppression with or without ultraviolet therapy. These cases highlight the importance of meticulous clinicopathological correlation with careful exclusion of mimicking conditions to arrive at the correct diagnosis.
移植物抗宿主病（GVHD）是造血细胞移植后最常见的并发症，常影响皮肤。急性和慢性 GVHD 通常表现为斑丘疹至麻疹样皮疹和硬化性或苔藓样病变；然而，有时也会出现非典型表现，如湿疹样 GVHD。我们描述了三例 GVHD 患者，其皮肤表现多样且多样，包括水疱样和血管炎样皮疹以及红斑性斑块和丘疹鳞屑性皮疹，皮肤活检显示具有共同的组织病理学发现，同时伴有海绵状皮炎和空泡界面反应伴凋亡角质形成细胞的改变。此外，还回顾了先前报道的湿疹样 GVHD 病例的临床和病理特征。需要强调的是，疾病的病程可能会有所不同，成功的治疗通常需要多种治疗方式的联合，包括免疫抑制治疗，或联合或不联合紫外线治疗。这些病例强调了仔细的临床病理相关性的重要性，并仔细排除模拟情况以做出正确诊断的重要性。
