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Acral keratotic graft versus host disease simulating warts
The Australasian Journal of Dermatology
|August 10, 1999
Summary
A patient developed unusual wart-like skin lesions after a stem cell transplant for chronic myeloid leukemia. These lesions may be an atypical sign of graft-versus-host disease, potentially influenced by hydroxychloroquine treatment.
Area of Science:
- Hematology
- Dermatology
- Immunology
Background:
- Allogeneic stem cell transplantation (SCT) is a curative therapy for hematologic malignancies.
- Graft-versus-host disease (GVHD) is a common and serious complication following allogeneic SCT.
- Chronic GVHD can manifest with diverse mucocutaneous findings.
Observation:
- A 55-year-old man developed persistent oral GVHD post-SCT for chronic myeloid leukemia.
- Acral keratotic lesions resembling warts appeared on his hands and feet 12 months post-transplant.
- Skin biopsy revealed a lichenoid reaction with epidermal hyperplasia, excluding papillomavirus infection.
Findings:
- The patient's acral keratotic lesions showed partial regression with increased oral prednisone dosage.
- The presentation suggests an unusual manifestation of chronic GVHD.
- A potential cofactor role for hydroxychloroquine, used for oral GVHD, cannot be ruled out.
Implications:
- This case highlights the broad spectrum of potential skin manifestations in chronic GVHD.
- It underscores the importance of considering GVHD in post-SCT patients presenting with atypical skin lesions.
- Further investigation may be warranted to elucidate the role of medications like hydroxychloroquine in GVHD-related dermatoses.