Ann Dermatol.  2016 Feb;28(1):90-93. 10.5021/ad.2016.28.1.90.

Chronic Graft-Versus-Host Disease Mimicking Psoriasis in a Patient with Hemophagocytic Lymphohistiocytosis

• Jang S
• Kim IS
• Youn SW

• KMID: 2429487
• DOI: http://doi.org/10.5021/ad.2016.28.1.90

Abstract

Graft-versus-host disease (GVHD) is a common complication of bone marrow transplantation (BMT) that can be classified as acute or chronic. Chronic GVHD, which usually occurs more than 3 months after BMT, includes typical lichenoid or sclerodermatous lesions. Psoriasiform eruption is a rare clinical manifestation of chronic GVHD, and there have been no reports of psoriasiform chronic GVHD associated with hemophagocytic lymphohistiocytosis. A 33-year-old woman who was diagnosed with hemophagocytic lymphohistiocytosis 10 years ago visited our outpatient clinic with psoriasiform eruption over her entire body. She underwent allogeneic BMT 7 months previously from her sibling. Skin biopsy was performed on the lesion, and the histological features suggested GVHD. The psoriasiform lesions improved with narrow-band ultraviolet B phototherapy, with secondary vitiligo remaining on the corresponding locations.

Keyword

Bone marrow transplantation; Graft-versus-host disease; Hemophagocytic lymphohistiocytosis; Psoriasiform eruption; Psoriasis

MeSH Terms

Adult
Ambulatory Care Facilities
Biopsy
Bone Marrow Transplantation
Female
Graft vs Host Disease*
Humans
Lymphohistiocytosis, Hemophagocytic*
Phototherapy
Psoriasis*
Siblings
Skin
Vitiligo

Figure

• 

  Fig. 1 (A) Generalized erythematous papulosquamous lesions with whitish scales on the trunk (inlet) and erythematous papular lesion with whitish scales. (B) Improved skin lesions with remaining widespread hypopigmentation 8 weeks after the start of therapy. Some hyperpigmented spots corresponding to hair follicles were suspected to be due to repigmentation.

• 

  Fig. 2 Histopathology of skin lesions (H&E, ×100). Interface dermatitis with perivascular and periappendageal lymphocytic infiltration, apoptotic keratinocytes, exocytosis of lymphocytes, hyperkeratosis, and parakeratosis (inlet, ×400); dyskeratotic cells seen in the epidermis.

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