Acute follicular graft-vs-host reaction. A distinct clinicopathologic presentation

Acute Follicular Graft-versus-Host Disease

“…is not uncommon [2], it is rare that an crythematous-to-violaceous follicular papular eruption develops as a major clinical presentation of acute cutaneous GVHD. We are aware of only 5 similar cases that have been reported previously [5,7], However, it is important to rec ognize that the follicular papular eruption is a skin manifes tation of acute cutaneous GVHD.…”

“…The skin is frequently the initial site of involvement in acute GVHD [2. 3], Saurat and Gluckman [6] have shown long before the report of Friedman et al [5] that, in 2 cases of GVHD. follicular pap ules developed on days 62 and 120 after BMT, respectively.…”

“…Thus, interstitial pneumonitis in allogeneic transplant recipients may be a clinical manifestation of GVHD. Although the 3 patients reported by Friedman et al [5], 2 by Lycka and Kaye [7] and our patient who had acute follicular GVI ID all died, it is still unknown if acute follicular GVHD may indicate a more severe course than other types of acute cutaneous GVHD [5,7], Sale et al 112] and Murphy et al [13] have demon strated predilection of acute GVHD for the rcte ridges and hair follicles, and suggested that the stem cells at the tip of epidermal rete ridges (14] and in the bulge area of hair fol licles ¡15] may be the targets in cutaneous GVHD. It remains to be understood why erythematous-to-violaceous follicular papules still represent a rare clinical pattern of acute cutaneous GVHD.…”

“…In acute GVHD, the skin biopsy may be an important diagnostic procedure because most patients have skin lesions in conjunction with internal organ involvement and the skin is often the initial site of involvement [2,3], The first recognizable visible skin changes in acute cutaneous GVHD arc maculopapular or scarlatiniform rashes. In severe cases, these rashes develop into toxic-epidermal-necrolysis-like form of acute cuta neous GVHD [4], Recently, Friedman et al [5] have reported unusual cases of acute cutaneous GVHD follow ing allogeneic BMT in which erythematous-to-violaceous follicular papules constituted a major clinical pattern of cutaneous involvement. We present here another case of acute follicular GVHD documented by clinical, histopath ologic and immunohistochemical analysis.…”

Severe Cutaneous Adverse Reactions

“…AGVHD frequently begins acrally and spreads proximally in contrast to TEN, which begins on the trunk and spreads distally. Also, the early exanthem of AGVHD has a folliculocentric distribution [117].…”