Diagnostic challenge in recurrent skin rash after autologous bone marrow transplantation.
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.
Inaba
Hiroto
H
Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
Hale
Gregory
G
Leung
Wing
W
Woodard
Paul
P
Burnette
Ken
K
Handgretinger
Rupert
R
Barfield
Ray
R
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