Chronic graft-versus-host disease: clinical presentation of multiple\nlesions of lichenoid and atrophic pattern
A 52-year-old male patient presented with a history of an allogeneic bone-marrow\ntransplant (matched sibling donor) performed in a reference Hospital, due to acute\nmyeloid leukemia one year before. A conditioning regimen had been followed with oral\nbusulfan and fludarabine phosphate and he was immunosuppressed from day 2 pre-transplant\nwith cyclosporine, initial dose of 3mg/kg and 7mg/kg after the 21th day\npost-transplant, sustained for 241 days plus tacrolimus and mycophenolate mofetil for\nseven and 45 days respectively. The patient denied acute GVHD and his clinical follow-up\nwas unremarkable until six months post-transplant, when oral and skin lesions of chronic\nGVHD appeared. Since then the patient has been treated with prednisone up to 1mg/kg/day\nwith partial remission of the clinical picture. The initial skin lesions were described\nas erythematous and pruriginous papules, starting on the trunk with progressive\nspreading and oral lesions similar to lichen planus, with ulcers on the lower lip\ncausing restriction to mouth opening.\nExamination showed diffuse spotted hyper and hypopigmented skin, multiple lichenoid and\natrophic lesions plus almost complete scarring alopecia, acral edema and erythema plus\nonychodistrophia of the 20 nails (-). Buccal examination showed shallow ulcers on the\nbuccal mucosa and tongue, periodontal disease, salivary gland hypofunction, depapillated\ntongue and decreased taste. No pulmonary, gastrointestinal or renal involvement was\ndetected. Histology of skin lesions showed discrete hyperkeratotic and atrophic\nepidermis with vacuolar interface dermatitis and scattered apoptosis of keratinocytes\nplus superficial sclerosis, vascular proliferation and mild lymphocytic infiltrate,\nsuggestive of late evolution of lichenoid lesions ( and ).