Steroid-Refractory Cutaneous Graft-versus-Host Disease: a Case Report

Area of Science:

• Hematology
• Immunology
• Dermatology

Background:

• Allogeneic hematopoietic stem cell transplantation (HSCT) can lead to graft-versus-host disease (GVHD), a significant post-transplant complication.
• Cutaneous GVHD is a common manifestation, but refractory cases pose a therapeutic challenge.

Purpose of the Study:

• To present a case of severe, steroid-refractory cutaneous graft-versus-host disease (GVHD) with toxic epidermal necrolysis-like progression.
• To highlight the management strategies and outcomes in a complex HSCT patient.

Main Methods:

• Case report of a 40-year-old female with acute myeloid leukemia undergoing allogeneic HSCT.
• Management of refractory cutaneous GVHD involved second and third-line therapies including JAK inhibitors (ruxolitinib), IVIG, biologics (infliximab, rituximab), and extracorporeal procedures (photopheresis, plasmapheresis).

Main Results:

• The patient developed generalized lesions consistent with toxic epidermal necrolysis-like GVHD.
• Multidisciplinary intervention and timely management led to disease control and progressive improvement of skin lesions.

Conclusions:

• Early recognition and aggressive, multidisciplinary management are essential for severe cutaneous GVHD.
• Tailoring treatment based on severity and clinical response is critical to reduce morbidity and mortality in HSCT patients.