ReportTissue eosinophils and the perils of using skin biopsy specimens to distinguish between drug hypersensitivity and cutaneous graft-versus-host disease☆
Section snippets
Case 1
A 44-year-old woman with chronic lymphocytic leukemia underwent allogeneic-matched unrelated-donor peripheral blood stem cell transplant after conditioning with fludarabine and busulfan. She received GvHD prophylaxis with cyclosporine, prednisone, and mycophenolate mofetil. On post-BMT day 54 the patient developed fever of unclear origin, for which she received treatment with multiple antibiotics during the following weeks. Shortly after development of symptoms, prednisone and mycophenolate
Discussion
GvHD is a serious and frequent complication after BMT. Clinically relevant acute GvHD occurs in 35% to 50% of patients receiving HLA-identical grafts,1 and progressive GvHD may carry a mortality as high as 80%.2 Acute GvHD frequently begins in the skin, presenting as a morbilliform rash that involves the trunk, neck, cheeks, and ears.5 This rash is often difficult to distinguish clinically from drug eruptions or viral exanthems, and skin biopsies are frequently requested in an attempt to narrow
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Conflicts of interest: None identified.