Iatrogenic cutaneous graft versus host disease

Area of Science:

• Hematology
• Immunology
• Dermatology

Background:

• Bone marrow allotransplantation is a curative therapy for acute myeloid leukemia.
• Graft-versus-host disease (GVHD) is a common complication following allogeneic bone marrow transplantation.
• Systemic chronic GVHD can affect multiple organ systems, including the skin.

Observation:

• A patient achieving complete remission from systemic chronic GVHD experienced a recurrence of localized cutaneous GVHD.
• This localized GVHD developed subsequent to topical treatment for viral cutaneous warts.
• No systemic reactivation of GVHD symptoms was observed concurrently.

Findings:

• The localized cutaneous GVHD reactivation was potentially induced by the Koebner phenomenon following local therapies.
• This represents a novel observation, as GVHD development after local immunomodulatory or cytotoxic treatments has not been previously described.
• Topical treatments are frequently employed for dermatological conditions in high-risk populations like transplant recipients.

Implications:

• Dermatologists and other practitioners should be aware of the potential for localized GVHD reactivation after local skin treatments.
• The Koebner phenomenon may play a role in triggering cutaneous GVHD in susceptible individuals.
• This case underscores the importance of careful monitoring and consideration of GVHD in transplant patients presenting with new or worsening skin lesions after local interventions.