慢性移植物抗宿主病1例

报告一例慢性移植物抗宿主病。患者,男,26岁,骨髓移植后全身皮肤硬化、瘙痒伴色素沉着1年余。皮肤科检查：躯干、四肢皮肤弥漫性硬化、色素沉着,其上覆叶片状鳞屑,肢端部分皮疹破溃,少许渗液结痂。皮损组织病理检查：表皮萎缩,基底细胞液化变性及明显色素失禁,真皮全层胶原增生、增厚、均质化,血管周围稀疏淋巴细胞浸润,病理符合硬皮病样皮肤改变。     

慢性移植物抗宿主病1例

慢性移植物抗宿主病是同种异体器官移植后发生的一种严重的慢性并发症。现将笔者诊治的1例报告如下。     

慢性移植物抗宿主病1例

1临床资料 患者,男,50岁,因"确诊慢粒16月,异基因外周造血干细胞移植术后1年,全身红色皮疹伴口唇糜烂1月",于2003年2月19日入院.患者1年前体检时发现外周血白细胞156×109/L,脾大,查骨髓像:慢性粒细胞白血病,经羟基脲2g/天治疗,血象控制正常.     

慢性移植物抗宿主病一例

患者男,48岁。因乏力6年,喘憋4 年,四肢皮肤变硬、肌肉萎缩3年于2004 年4月来我院就诊。6年前患者在当地医院诊断为急性粒细胞白血病,部分分化型(AML-M2),并行同种异体基因骨髓移植(供者为其胞弟)。移植后1个月及3 个月分别行两次化疗。移植后4个月,出     

慢性移植物抗宿主病一例

患者女,３８岁。因双上肢硬化、萎缩,伴乏力、肌肉胀痛５个月而来诊,我科门诊以“慢性移植物抗宿主病？硬皮病？皮肌炎？”诊断收入院。２年前患者因乏力、消瘦伴发热住我院血液科,行骨穿诊断为慢性粒细胞白血病,尔后在北京行骨髓移植术,口服环孢素A２００mg／d,１年后逐渐减量至２５mg／d。半年前出现感冒伴高热,经抗炎治疗后好转。半个月后发现右上臂内侧出现数个豆粒大红斑、斑丘疹,腹部出现甲大水肿性红斑,曾服用抗组胺药无效。皮疹逐渐增多、融合,扩大为硬肿性红斑,３个月前皮疹逐渐蔓延至双上肢,出现挛缩、胀痛,腹部红…     

硬皮病样慢性移植物抗宿主病一例

患者,男,42岁。全身红斑、硬化、脱发9年。皮肤科查体：胸部、四肢、鼻周、口周等部位地图样斑块、色素脱失斑、萎缩、瘢痕,头顶部见脱发区,表面见色素脱失。腹部皮损组织病理示：表皮角化过度,基底细胞空泡变性伴色素失禁;真皮附属器减少,真皮浅层胶原纤维粗大、致密及玻璃样变。诊断：硬皮病样慢性移植物抗宿主病。     

扁平苔藓样慢性移植物抗宿主病一例

患者,男,40岁。躯干泛发苔藓样皮损伴瘙痒1个月。患者1年前因＂急性粒细胞白血病＂行异体造血干细胞移植术。皮损组织病理示基底细胞液化变性,有嗜酸性变的角质形成细胞似胶样小体,周围淋巴细胞卫星状分布,真皮浅层淋巴细胞等呈带状浸润。诊断：扁平苔藓型慢性移植物抗宿主病。     

硬皮病样慢性移植物抗宿主病3例

报告3例硬皮病样慢性移植物抗宿主病。患者均为男性，平均年龄48岁。因原发性血液系统疾病在化疗缓解后接受异体骨髓移植，移植后平均12．7个月出现仝身弥漫性硬化或泛发性硬斑，硬化严格以手腕、踝部和颈部为界，未累及肢体远端和面部，无雷诺现象和毛细血管扩张。其中2例伴有不同程度的肺间质病变。3例患者抗核抗体（ANA）、类风湿因子(RF）、抗Scl-70抗体和抗着丝点抗体均为阴性，组织病理检查显示真皮网状层胶原纤维束增粗、密集和肿胀。3例患者均接受中等剂量的糖皮质激素治疗，其中2例治疗1个月后皮肤明显软化，另1例软化不明显。     

肝移植术后急性移植物抗宿主病1例

急性移植物抗宿主病(acute graft-versus-host disease,aGVHD)是供体的同种反应性T细胞针对受体组织的破坏性免疫反应,常见于骨髓移植术后,发生于肝移植术后者少见,发生率为1%～2%,但死亡率高于85%[1].     

同种异体骨移植致慢性移植物抗宿主病1例

患者,男,47岁。1年前因外伤行左胫骨粉碎性骨折切开复位术,植入6 g同种异体骨及5枚可吸收螺钉。2个月后出现全身皮肤进行性肿胀、硬化。皮肤组织病理示:表皮厚度正常,基底细胞液化变性,真皮胶原纤维增粗,全层附属器周围淋巴细胞浸润。诊断为硬皮病样慢性移植物抗宿主病。     

皮肤异色病样表现的慢性移植物抗宿主病一例

患者男,22岁。因全身皮疹伴右睫毛变白1年余至苏州市立医院东区皮肤科就诊。患者于2015年2月无明显诱因出现牙龈出血,可自行止血。随后出现发热,伴咽部疼痛,无畏寒、寒战,无咳嗽、咳痰,于苏州大学附属第一医院诊断为急性髓系白血病M0型。2015年5月25日行母供子单倍体造血干细胞移植（血型A+,供体A+）。移植后数天曾出现腹泻、发热、咽痛、夜间尿频、尿胀,无肉眼血尿,最高体温38.1 ℃。患者造血重建期予广谱抗感染治疗,并用环孢素、短程甲氨蝶呤预防移植物抗宿主病,好转后出院……     

A pediatric case of sclerodermatous chronic graft-versus-host disease

We report a rare case of sclerodermatous chronic graft-versus-host disease (GVHD) in a 6-year-old boy that occurred after bone marrow transplantation for his aplastic anemia. The clinical manifestation and histopathologic findings were typical of scleroderma. Although various kinds of treatment have been tried for scleroderma, no established therapy exists. Furthermore, treating this disease is even more difficult in children. In the future, clarification of the pathogenesis of chronic GVHD and establishment of therapy will be necessary.     

A case of acute cutaneous graft-versus-host disease mimicking psoriasis vulgaris

Graft-versus-host disease (GVHD) is a frequent complication occurring after allogenic hematopoietic stem cell transplantation and is divided into acute and chronic type. Cutaneous involvement is the most frequent manifestation of acute GVHD, with maculopapular exanthema and perifollicular papular lesions. We describe the first case to develop acute cutaneous GVHD mimicking psoriasis vulgaris shortly after allogenic peripheral blood stem cell transplantation. The patient's rash resembled psoriasis vulgaris and showed histologic features of both psoriasis and acute GVHD. Despite various immunosuppressant therapies, the skin lesion was drug-resistant. Therefore, we administered psoralen-UVA (PUVA) therapy and achieved the desired therapeutic effect. As far as we know, this is the first case of psoriasiform skin eruption as a manifestation of acute GVHD.     

A case of sclerodermatous graft-versus-host disease responsive to imatinib therapy

Sclerodermatous graft-versus-host disease (sGVHD) is a rare, late complication of hematopoietic cell transplantation. Classified as a variant of chronic graft-versus-host disease, sGVHD is thought to be predominantly an immune-mediated response characterized by aberrant T-cell function and dysregulation of tyrosine kinase cascades. Recently, the profibrotic cytokine transforming growth factor B and stimulatory autoantibodies against the platelet-derived growth factor receptor have been implicated in the pathogenesis of sGVHD. Treatment of sGVHD remains disappointing and largely limited by systemic side effects. Imatinib mesylate is a small molecule tyrosine kinase inhibitor that has been shown to selectively inhibit both the platelet-derived growth factor receptor and transforming growth factor-β signaling pathways. We report a case of sGVHD in a pediatric patient that was resistant to traditional therapy but showed improvement in cutaneous symptoms following daily treatment with 400 mg of imatinib mesylate. Due to its favorable side-effect profile, specificity for molecular pathways deranged in sGVHD and proven efficacy in other sclerodermoid diseases, imatinib mesylate is a promising new tool in the management of this challenging disease.     

Psoriasiform graft-versus-host disease responded to secukinumab: A case report

We describe a 9-year-old boy who developed generalised erythematous lesions 12 months after haematopoietic stem cell transplant (HSCT). Histopathology showed both features of psoriasis and graft-versus-host disease (GVHD). The lesions responded well to secukinumab, suggesting that IL-17A monoclonal antibody might be a treatment option for GVHD.     

表现为扁平苔藓样的慢性移植物抗宿主病一例

<正>临床资料患者,男,26岁。主因全身起皮损伴瘙痒2年零6个月,于2015年1月20日就诊。患者2012年7月因急性淋巴细胞白血病行供者为其父的6/6相合异基因造血干细胞移植,血型O-O。术后口服醋酸泼尼松60 mg每日1次、环孢素100 mg每日2次、吗替麦考酚酯500 mg每日3次、伊曲康唑200 mg每日2次及阿昔洛韦400 mg每日2次治疗。术后3周,     

Chronic cutaneous graft-versus-host disease simulating hypertrophic lupus erythematosus--a case report of a new morphologic variant of graft-versus-host disease

The spectrum of clinical and histopathologic features associated with chronic graft-versus-host disease (GVHD) is broad, with recognized variants simulating scleroderma, lichen sclerosus, eosinophilic fasciitis, and de novo diffuse melanoderma. We report a case of a patient with multiple myeloma who presented approximately 1 year after his allogeneic hematopoietic stem cell transplantation with lesions of chronic lichenoid GVHD that harbored features of hypertrophic lupus erythematosus (LE) and that was initially mistaken for a superficial well-differentiated squamous cell carcinoma (SCC). However, in 4 years of follow-up, the patient failed to develop any evidence of cutaneous or systemic LE, actinic damage, or SCC, and the lesions cleared with topical and systemic treatments appropriate for chronic GVHD. For proper interpretation of the histologic findings of GVHD, it is important for the dermatopathologist to be aware of unusual manifestations. Knowledge of the occurrence of hypertrophic LE and familiarity with its histologic features is also important to avoid an erroneous diagnosis of SCC in immunosuppressed patients.     

A case of acute graft-versus-host disease following autologous peripheral blood stem cell transplantation

A 42-year-old woman developed severe erythema with exfoliative scaling on the bilateral palms and soles and erosive dermatitis on the axillae and groin eight days after an autologous peripheral blood stem cell transplantation for the treatment of non-Hodgkin's lymphoma. She also developed exanthema; however she did not show intestinal, hepatic, or renal involvement. The skin biopsy revealed characteristic apoptotic cell death of the epidermis with eosinophilic necrosis, and she was diagnosed with acute graft-versus-host disease (GVHD). The cutaneous lesions responded to topical corticosteroid treatments and improved within a month without systemic immunosuppressing therapies. The cutaneous GVH reaction did not recur. However, she was treated with an intermittent thrombocyte transfusion because of persistent thrombocytopenia. On day 130, she developed intestinal pneumonia and died due to respiratory dysfunction. Unlike an allo-bone marrow graft, GVHD after an autologous stem cell transplantation is not common. Even for an autologous transplantation, GVH may develop with less characteristic clinical manifestations.     

A case of sclerodermatous graft-versus-host disease following autologous peripheral blood stem cell transplantation

We report a 65-year-old woman with chronic graft-versus-host disease (GVHD) who developed severely sclerotic skin on the fingers, hand and trunk following autologous peripheral blood stem cell transplantation (APBSCT). The patient had suffered from breast cancer and been treated with surgery and chemotherapy. She showed pancytopenia and was treated with APBCST. Four years after APBSCT, she developed the severe sclerotic changes on the fingers, hands, extremities and trunk. The skin biopsy showed a flattened epidermis and a proliferation of collagen bundles in the dermis. No anti-nucleolar DNA titers were detected in the serum. She was diagnosed with chronic GVHD. Despite treatment with oral prednisolone, the skin sclerotic change developed and the breast cancer recurred. She died due to pericarditis. This is a rare case of sclerodermatous GVHD following APBSCT. The serum interleukin (IL)-12 levels were examined during the treatment.