Exanthema and enanthema in graft versus host disease (GVHD)

Two cases of graft versus host disease (GVHD) were reported. Case 1: A 74-year-old man noticed erythematous rash with high fever in fourteen days after blood transfusion. Skin rash spread gradually and resulted in toxic epidermal necrolysis (TEN) in accompany with diarrhea, liver dysfunction and pancytopenia. Case 2: A 24-year-old man with acute lymphocytic leukemia treated with allogeneic bone marrow transplantation, developed macular erythema diffusely and he had received transfusion of peripheral buffy coat cells from his brother. Histological findings revealed eosinophilic necrotic keratinocytes and infiltrating cells which consisted of CD4 and CD8(+) T cells. The both cases were diagnosed as GVHD caused by blood transfusion, though in case 1, differentiation from toxic eruption was needed. We described clinical and histopathological findings of the cutaneous manifestations of GVHD and distinction from some cutaneous lesions caused by drug toxicity and collagen disease.