title: Entrapment syndrome of multiple nerves in graft-versus-host disease.
abstract: BACKGROUND
  Peripheral nerve entrapment syndromes are associated with hereditary neuropathy with liability to pressure palsies and a variety of rheumatic and endocrinological diseases.
  
  
  METHODS
  We report a patient with entrapment syndromes of multiple nerves associated with chronic graft-versus-host-disease (GVHD) after allogeneic hematopoietic stem cell transplantation. Nerve ultrasound, histology, and ultrastructural changes were assessed.
  
  
  RESULTS
  The 51-year-old man had developed severe deep dermal sclerosis due to chronic GVHD with a progressive polyneuropathy and entrapment syndromes of multiple nerves. Pre-stenotic enlargement was shown by nerve ultrasound. Histology demonstrated fibrosis of the epineurium with scarce infiltration of macrophages. Electron microscopy demonstrated alterations of the myelin sheaths and marked depletion of normal-sized myelinated nerve fibers.
  
  
  CONCLUSIONS
  In addition to polyneuropathy, chronic GVHD can be associated with peripheral nerve entrapment syndromes and should be added to the differential diagnosis of compressive neuropathies.
authors.affiliation: Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Kleiter
authors.forename: Peter
authors.initials: P
authors.lastname: Poeschl
authors.forename: Peter D
authors.initials: PD
authors.lastname: Kraus
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Huber
authors.forename: Josef
authors.initials: J
authors.lastname: Schröder
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Schulte-Mattler
authors.forename: Ernst
authors.initials: E
authors.lastname: Holler
authors.forename: Daniel
authors.initials: D
authors.lastname: Wolff
mesh_terms: D015897:Comorbidity; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging / Q000648:ultrastructure; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D010543:Peroneal Nerve / Q000000981:diagnostic imaging / Q000648:ultrastructure; D011115:Polyneuropathies / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D011239:Prednisolone / Q000627:therapeutic use; D011826:Radial Nerve / Q000000981:diagnostic imaging / Q000648:ultrastructure; D014459:Ulnar Nerve / Q000000981:diagnostic imaging / Q000648:ultrastructure; D014463:Ultrasonography
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone
keywords: GVHD; entrapment syndrome; fibrosis; hematopoietic stem cell transplantation; polyneuropathy