Case Number : Case 775 - 6th June Posted By: Guest

GVHD

The combined presence of GVHD features and marked spongiosis suggests the eczematoid variant of GVHD.

GVHD

Microscopic features are typical of acute graft-versus-host disease in the proper setting of the given case history, but the late onset of the cutaneous rash is not. I go with late manifestation of acute graft-versus-host disease.
It could be graded as 2 since there are both basal vacuolization and dyskeratotic keratinocytes.
Lymphocytic infiltrate is sparse, as might be expected after bone marrow transplantation.

MUD???

MUD = matched unrelated donor.

GVHD

GVHD

Necrotic keratinocyte surrounded by cytotoxic lymphocyte (satellite cell necrosis).
Goofd for GVHD.

gvhd

It looks like acute GVHD by histology, agree grade 2. Agree that onset is very late for acute, as this would be chronic GVHD by history, if rigorously following date definitions of acute-vs-chronic (>100 days post-transplant = chronic). Would doubt a drug etiology with the smoking gun we have.

Chronic GVHD can have variable clinical presentations, including eczematous or maculopapular process similar to those of acute GVHD. ref: Abstract [url="http://www.ncbi.nlm.nih.gov/pubmed/20868623"]J Cutan Med Surg. 2010 Sep-Oct;14(5):249-53.[/url]

We don't have clinical history as to whether this is a first presentation or a persistent process. There is spongiosis, satellite cell necrosis, lymphocyte exocytosis, and subtle vacuolar change. There is modest accumulation of melanophages that suggest a subacute process, but no sclerotic changes or lichen-planus like epidermal changes that would be expected in a classic chronic GVHD.

GVHD

GVHD.