The role of skin biopsies in bone marrow transplant recipients.

Bone marrow transplant (BMT) recipients frequently develop rashes as a consequence of their disease, its treatment or because of a complication such as infection. These rashes are often clinically atypical, yet appropriate management is dependent upon correct diagnosis and therefore a skin biopsy is often performed. In a group of 101 consecutive BMT recipients, 25 patients had a total of 34 skin biopsies. A specific histopathological diagnosis was made in 65% (22/34), including graft vs. host disease (GVHD) (15 cases), infection (4 cases), drug reaction (1 case) and recurrent lymphoma (1 case). Therapy was changed following the biopsy in 77% (17/22) of these cases. In 35% (12/34) the histological changes were non-specific, however, in 10 of these cases GVHD had been suspected clinically and its exclusion was therefore useful. Skin biopsy is of considerable value in the diagnosis and subsequent management of BMT recipients who develop a rash.