Residency Program - Case of the Month
February 2015 - Presented by Nima Amini, M.D.
- Chronic graft-versus-host disease which is a major cause of morbidity and mortality in allogenic stem cell transplantation survivors. In this condition, donor T-lymphocytes attack host tissues and the cytokine production pattern is mostly TH2 type.[1,2] A punch skin biopsy of abdomen in our patient confirmed the diagnosis. The microscopic findings were as follows:
Minimal junctional vacuolar alteration and rare single apoptotic/necrotic keratinocytes along the dermal-epidermal junction and very sparse superficial predominant lymphocytic infiltrates with mostly melanophages in the papillary dermis, and sclerosis of the deep reticular dermis, abutting subcutis, creating a prominent linear demarcation between deep dermis and subcutis ("line sign").
3. T-lymphocyte deactivation to mitigate chronic GVHD
4. II - Apheresis is accepted as second-line therapy. 1B - Strong recommendation, moderate-quality evidence.
5. We will continue to provide photopheresis until his chemotherapy regimen/schedule plans are finalized.
1. V Ratanatharathorn, L Ayash, H M Lazarus, J Fu and J P Uberti. Chronic graft-versus-host disease: clinical manifestation and therapy. Journal of Bone Marrow Transplantation. July (2) 2001, Volume 28, Number 2, pp 121-129
2. Hakim F, Mackall CL. The immune system: effector and target of graft-versus-host disease. In: Ferrara JL, Deeg HJ, Burakoff SJ (eds). Graft-vs-Host Disease. Marcel Dekker: New York, 1997, pp 257-289.