[Chronic graft-versus-host disease presenting as bullous lesions].
Graft-vs-host disease is still the leading cause of morbidity and mortality in patients undergoing bone marrow transplantation. It is important to start treatment early to reduce the severity and consequences of this complication. Cutaneous lesions are often the presenting compliant of graft-vs-host disease and presage visceral involvement. We present the case of a 45-year-old woman with multiple myeloma who underwent autologous and subsequently allogeneic bone marrow transplantation with hematopoietic precursors. She developed bullous lesions with fluid elimination on the abdomen and legs. Biopsy findings were compatible with graft-vs-host disease and immunosuppressive therapy was increased. She subsequently presented oral lichenoid lesions and sicca syndrome. The bullous lesions progressed to painful ulcers that healed leaving highly sclerodermatous skin with substantial hyperpigmentation. Bullous lesions are a rare form of presentation of chronic graft-vs-host disease. In such cases, the diagnosis may not be suspected initially, particularly when the lesions are isolated and internal organs are not involved.
del Pozo
J
J
Servicio de Dermatología, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, España. del_pozo@canalejo.org
García-Silva
J
J
Yebra-Pimentel
M T
MT
D001706:Biopsy; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017676:Lichen Planus, Oral / Q000209:etiology; D008548:Melanosis / Q000209:etiology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D011701:PUVA Therapy; D012086:Reoperation; D012859:Sjogren's Syndrome / Q000209:etiology; D012867:Skin / Q000473:pathology; D012872:Skin Diseases, Vesiculobullous / Q000188:drug therapy / Q000209:etiology*; D012883:Skin Ulcer / Q000209:etiology; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous / Q000009:adverse effects
D007166:Immunosuppressive Agents