Grace Y Kim1, Leah A Schmelkin2, Mark D Davis3, Rokea A El-Azhary3, Carilyn N Wieland3,4, Michael D Leise5, Alexander Meves3, Julia S Lehman3,4. 1. Mayo Clinic School of Medicine, Rochester, Minnesota. 2. Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota. 3. Department of Dermatology, Mayo Clinic, Rochester, Minnesota. 4. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. 5. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND: Graft-versus-host disease (GVHD) following solid organ transplantation (SOT) is extremely rare and infrequently described in the dermatologic literature. METHODS: We performed a retrospective clinicopathologic review of our institution's experience with patients diagnosed with SOT-associated GVHD (SOT GVHD) (May 1, 1996 to September 1, 2017). RESULTS: Of nine patients with SOT GVHD, seven had undergone liver transplantation, while two had undergone lung transplantation. All presented initially with a skin eruption, which developed an average of 63 days (range: 11-162 days) post transplant. The average time to diagnosis following the onset of the skin eruption was 12 days (range: 0-54 days). Diagnosis was often delayed because of a competing diagnosis of drug reaction. Frequent skin findings included pruritic erythematous to violaceous macules and papules with desquamation. Histopathology showed vacuolar interface dermatitis in 12 of 15 cases (80.0%). Of the 11 specimens in which a hair follicle was present for evaluation, vacuolar interface changes around the hair follicle were present in eight (72.7%) cases. Seven patients (77.8%) died from complications during the follow-up period. CONCLUSIONS: SOT GVHD presents initially with skin involvement, is associated with vacuolar interface changes on skin biopsy, and is associated with a high mortality rate. Clinicopathologic correlation is required for accurate diagnosis.
BACKGROUND:Graft-versus-host disease (GVHD) following solid organ transplantation (SOT) is extremely rare and infrequently described in the dermatologic literature. METHODS: We performed a retrospective clinicopathologic review of our institution's experience with patients diagnosed with SOT-associated GVHD (SOT GVHD) (May 1, 1996 to September 1, 2017). RESULTS: Of nine patients with SOT GVHD, seven had undergone liver transplantation, while two had undergone lung transplantation. All presented initially with a skin eruption, which developed an average of 63 days (range: 11-162 days) post transplant. The average time to diagnosis following the onset of the skin eruption was 12 days (range: 0-54 days). Diagnosis was often delayed because of a competing diagnosis of drug reaction. Frequent skin findings included pruritic erythematous to violaceous macules and papules with desquamation. Histopathology showed vacuolar interface dermatitis in 12 of 15 cases (80.0%). Of the 11 specimens in which a hair follicle was present for evaluation, vacuolar interface changes around the hair follicle were present in eight (72.7%) cases. Seven patients (77.8%) died from complications during the follow-up period. CONCLUSIONS: SOT GVHD presents initially with skin involvement, is associated with vacuolar interface changes on skin biopsy, and is associated with a high mortality rate. Clinicopathologic correlation is required for accurate diagnosis.
Authors: Stuart S Kaufman; Elsadig Hussan; Alexander Kroemer; Olga Timofeeva; Helena B Pasieka; Juan Francisco Guerra; Nada A Yazigi; Khalid M Khan; Udeme D Ekong; Sukanya Subramanian; Jason S Hawksworth; Raffaelle Girlanda; Shahira S Ghobrial; Thomas M Fishbein; Cal S Matsumoto Journal: Transplant Direct Date: 2021-07-19