Cutaneous lichenoid graft-versus-host disease mimicking lupus erythematosus

Abstract

Graft-versus-host disease (GVHD) is the main complication of allogeneic bone marrow transplantation and the skin is the most commonly involved organ. The clinical presentation is varied and may resemble autoimmune diseases, such as scleroderma, lichen planus or lichen sclerosus. Chronic GVHD presenting with a butterfly malar rash mimicking lupus erythematosus is uncommon. We report a series of five patients with cutaneous lichenoid GVHD that presented with a butterfly malar rash. Two of our patients had positive antinuclear antibody titres. The evolution was poor with development of sclerodermatous GVHD lesions in three patients and relapse of their haematological disease in two.

Cytokine-Producing Dendritic Cells in the Pathogenesis of Inflammatory Skin Diseases

“…Additionally, pDCs, which also express CXCR3, migrate into inflamed skin, where local IFN-α can stimulate them to produce more IFN [8], thus perpetuating the inflammatory process. Thus pDCs may contribute directly to T cell infiltration and the lichenoid tissue reaction characteristic of cutaneous lupus [76, 77]. …”

Chronic Cutaneous Graft-Versus-Host Disease Simulating Hypertrophic Lupus Erythematosus—A Case Report of a New Morphologic Variant of Graft-Versus-Host Disease

“…Two of the patients had positive antinuclear antibody titers. 6 The individual lesions on the face, erythematoviolaceous papules with a scaling surface, resembled a lichenoid eruption, and in all the patients, similar lesions were present outside the face, which, together with the clinical context, suggested the diagnosis of a chronic lichenoid GVHD. None of the patients in this series presented any systemic symptoms suggestive of LE, and none had a history of photosensitivity; in fact, the onset of the lesions was in winter in 3 of the patients.…”

Cutaneous Hematopathology

“…The primary differential diagnosis includes lichen planus (Romero et al 1977 ;Oliver et al 1989 ), chronic graft-versus-host disease Goiriz et al 2008 ), drug eruptions , and lichenoid mycosis fungoides (Friss et al 1995 ) (Table 5.13 ). In typical cases, lichen planus has an infi ltrate limited to the dermal epidermal junction, with accompanying cytoid body formation and Max Joseph clefts.…”

“…However, there can be signifi cant overlap between lichen planus and lichenoid lupus erythematosus in certain circumstances (Romero et al 1977 ;Oliver et al 1989 ), and careful clinical correlation with clinical follow-up may be the only way to distinguish between the two entities. Chronic graft-versushost disease can have a lichenoid pattern and can rarely mimic lupus Goiriz et al 2008 ). The clinical setting can help distinguish between the two entities; in addition, dermal mucin deposition is not seen in lichenoid graftversus-host disease (Goiriz et al 2008 ).…”

“…Chronic graft-versushost disease can have a lichenoid pattern and can rarely mimic lupus Goiriz et al 2008 ). The clinical setting can help distinguish between the two entities; in addition, dermal mucin deposition is not seen in lichenoid graftversus-host disease (Goiriz et al 2008 ). Drug eruptions resolve when an offending agent is removed, and this may be a good way to distinguish between a drug-related event and idiopathic lupus erythematosus .…”