Dyskeratosis congenita or chronic graft-versus-host disease? A diagnostic dilemma in a child eight years after bone marrow transplantation for aplastic anemia.
A 12-year-old boy had striking reticulate hyperpigmentation of the neck and upper chest, dystrophic nails, patchy alopecia, and a white streak on the buccal mucosa. He was diagnosed as having chronic graft-versus-host disease (GVHD) based on clinical findings, skin biopsy findings, and his history of a bone marrow transplantation for aplastic anemia eight years earlier. Dyskeratosis congenita (DC) was not a diagnostic consideration, although the clinical findings and history of aplastic anemia made it a compelling possibility. This case highlights the clinical similarities between DC and chronic GVHD and the difficulty in arriving at an unequivocal diagnosis.
Ivker
R A
RA
Department of Dermatology, University of North Carolina at Chapel Hill 27514.
Woosley
J
J
Resnick
S D
SD
D000741:Anemia, Aplastic / Q000628:therapy*; D016026:Bone Marrow Transplantation; D002648:Child; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006086:Graft vs Host Disease / Q000175:diagnosis*; D006801:Humans; D017495:Hyperpigmentation / Q000151:congenital / Q000175:diagnosis; D008297:Male; D009260:Nail Diseases / Q000151:congenital / Q000175:diagnosis; D012871:Skin Diseases / Q000151:congenital* / Q000175:diagnosis*; D013997:Time Factors