title: Diagnostic challenge in recurrent skin rash after autologous bone marrow transplantation.
abstract: Engraftment syndrome, autologous graft-versus-host disease (GVHD), and infection after autologous hematopoietic cell transplantation can have similar clinical presentations. Here, we describe a patient with refractory Ewing sarcoma who had recurrent skin rash after autologous hematopoietic cell transplantation. Although the rash was diagnosed as GVHD histologically, this case illustrates the diagnostic dilemma of distinguishing engraftment syndrome, autologous GVHD, or concomitant viral infection. Because therapy for these entities is different, distinguishing them is important. Establishment of diagnostic criteria and understanding of the pathophysiology of these entities may lead to better management and to improved therapy of refractory cancer.
authors.affiliation: Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Inaba
authors.forename: Gregory
authors.initials: G
authors.lastname: Hale
authors.forename: Wing
authors.initials: W
authors.lastname: Leung
authors.forename: Paul
authors.initials: P
authors.lastname: Woodard
authors.forename: Ken
authors.initials: K
authors.lastname: Burnette
authors.forename: Rupert
authors.initials: R
authors.lastname: Handgretinger
authors.forename: Ray
authors.initials: R
authors.lastname: Barfield
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D005076:Exanthema / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006801:Humans; D012008:Recurrence; D016879:Salvage Therapy; D012512:Sarcoma, Ewing / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D014182:Transplantation, Autologous; D014777:Virus Diseases / Q000175:diagnosis