Acute and chronic graft-vs-host reaction in skin: report of two cases

The cutaneous changes of the acute form of graft-vs-host reaction are described in two patients who underwent bone marrow transplantation for treatment of severe aplastic anaemia. One patient went on to develop a chronic reaction of the lichenoid type. Histopathology confirmed the presence of 'satellite cell necrosis' from the acute stage of the disease onwards. Direct immunofluorescence showed deposits of immunoglobulin (IgG, IgM), fibrinogen and complement on the necrotic keratinocytes, whilst the basement membrane was positive for C3. These findings suggest that humoral immunity as well as cellular immunity may play a part in the production of the rash.