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

Cutaneous graft-versus-host disease (cGVHD) is a potentially severe complication following allogeneic hematopoietic stem cell transplantation. We present the case of a 40-year-old woman with acute myeloid leukemia who underwent an allogeneic transplant with an HLA-matched unrelated donor. During the post-transplant phase, she developed steroid-refractory cutaneous GVHD, progressing to widespread lesions compatible with toxic epidermal necrolysis (NET-like). Management included second- and third-line therapies, such as JAK inhibitors (ruxolitinib), immunoglobulin, biological agents (infliximab, rituximab), and extracorporeal procedures (photopheresis and plasmapheresis). Early intervention and coordination by a multidisciplinary team allowed disease control and progressive improvement of the lesions. This case emphasizes the importance of early recognition of severe cutaneous GVHD, tailoring treatment according to disease severity and clinical response, and the need for a multidisciplinary approach to reduce morbidity and mortality.