Columnar epidermal necrosis: a unique manifestation of transfusion-associated cutaneous graft-vs-host disease.
BACKGROUND
In 1978, the first case of columnar epidermal necrosis was reported in a 6-year-old boy. There were scaly, partially vesicular or crusty, erythematous lesions mainly involving the extremities that histopathologically showed peculiar features of focal, total epidermal necrosis accompanied by a lichenoid tissue reaction. He developed the skin eruption after receiving a blood transfusion from his mother when he showed debility induced by vaccination with an alternated live measles virus vaccine. The lesions rapidly regressed after sun exposure. To our knowledge, there has been no report of a similar case despite such unique features.


METHODS
We encountered a similar case of columnar epidermal necrosis in a 15-year-old Japanese girl with chronic graft-vs-host disease; the lesions occurred 3 months after the transfusion of peripheral blood stem cells from her HLA antigen-matched brother. However, there was no exacerbation of liver dysfunction, diarrhea, or bone marrow aplasia. The peculiar cutaneous lesions responded well to topical phototherapy.


CONCLUSIONS
These 2 patients shared a similarity in their lesions and circumstances under which the blood transfusion was performed to a debilitated patient from a close family member. We believe that focal epidermal necrosis observed in patients with this condition represents a variant of blood transfusion-associated lichenoid graft-vs-host disease that occurs uniquely in a skin-targeted fashion.
Saijo
S
S
Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan.
Honda
M
M
Sasahara
Y
Y
Konno
T
T
Tagami
H
H
D000293:Adolescent; D001706:Biopsy; D002648:Child; D004817:Epidermis / Q000473:pathology*; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D017512:Lichenoid Eruptions / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D009336:Necrosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology / Q000628:therapy*