Current Issue
Autumn/Winter 2023, Vol. 31 No. 1
Hong Kong J. Dermatol. Venereol. (2023) 31, 5-13
Original Article
Case series of cutaneous graft-versus-host disease (GVHD) in patients receiving haematopoietic stem cell transplantation in a tertiary Malaysian hospital
馬來西亞一所第三級醫院接受造血幹細胞移植病人發生皮膚移植物抗宿主病的病例系列
SS Yong, WH Han, RKJ Choong, NAA Faheem, YF Toh, PC Bee, Z Kwan
Abstract
Introduction: Acute and chronic graft-versus-host disease (GVHD) are multisystem disorders which are complications of haematopoietic stem cell transplant (HSCT). It is important to consider other differential diagnoses that may have similar clinical and histopathologic features as GVHD. Method: A retrospective analysis was conducted on adult patients from a single centre who developed GVHD after HSCT between January 2014 and June 2018. Results: Fourteen patients were included where 13 had acute GVHD and 1 had chronic GVHD. The median age was 35.0 years (IQR 26 to 44 years) while median onset of cutaneous symptoms for acute GVHD was 70 days (IQR 17.0-96.5 days). All cases had histopathological confirmation. For acute GVHD (n=13), classical presentation with generalised exanthem and perifollicular erythema is the commonest (84.6%, n=11), where 61.5% and 38.5% of patients had stage 2 and 3 extent of skin involvement, respectively (n=8, n=5). 76.9% (n=10) of patients with acute GVHD had other organs involvement, such as liver, eyes, and gut. Lerner's grade 2 was the most common histological grade for patients with acute GVHD (53.8%, n=7) followed by grade 1 (38.5%, n=5). One patient with chronic GVHD had lichen planus-like presentation. All patients had received various antibiotics within two months prior to onset. None of the skin biopsies showed significant eosinophilic infiltrates. Conclusion: Cutaneous manifestations of GVHD are among the earliest presenting complaints among patients who have undergone HSCT. Half of these patients only had skin GVHD without any other organs involvement. Hence, biopsy is important to confirm the diagnosis of GVHD along with clinical correlation.
簡介：急性和慢性移植物抗宿主病是一種多系統疾病，是造血幹細胞移植的併發症之一。重要的是要考慮可能與此病具有相似臨床和組織病理學特徵的其他鑑別診斷。方法：對 2014 年 1 月至 2018 年 6 月期間單一中心造血幹細胞移植後發生移植物抗宿主病的成年患者進行回顧性分析。結果：共納入 14 位患者，其中急性移植物抗宿主病 13 例，慢性 1 例。中位數年齡為 35.0 歲（四分位距 [IQR] 為 26 至 44 歲），而急性移植物抗宿主病皮膚症狀的中位數發病時間為 70 天（四分位距 [IQR] 為 17.0-96.5 天）。所有病例均有組織病理學證實。對於急性移植物抗宿主病(n=13)，全身性皮疹和毛囊周圍紅斑的典型表現是最常見的(84.6%，n=11)，其中 61.5% (n=8) 和 38.5% (n=5) 的患者分別有第 2 級和第 3 級皮膚受累程度 (n=11)。當中有76.9% (n=10) 的急性移植物抗宿主病患者有其他器官受累，如肝臟、眼睛和腸道。勒納分級（Lerner grading）第 2 級是急性移植物抗宿主病患者最常見的組織學程度級別（53.8%，n=7），其次是第 1 級（38.5%，n=5）。一名慢性移植物抗宿主病患者則出現扁平苔癬樣表現。所有患者均在發病前兩個月內接受過各種抗生素治療，皮膚切片檢查俱未顯示明顯的嗜酸性粒細胞浸潤。結論：移植物抗宿主病的皮膚表現是接受造血幹細胞移植者當中最早出現的相關反應之一。這些患者中有一半僅出現皮膚移植物抗宿主病，而沒有其他器官受累。因此，臨床相關性再加上活檢對於確認移植物抗宿主病的診斷實為重要。
Keywords: Graft versus host disease, Haematopoietic stem cell transplant, Histopathology of GVHD, Skin biopsy for GVHD
關鍵詞: 移植物抗宿主病、造血幹細胞移植、移植物抗宿主病的組織病理學、移植物抗宿主病的皮膚切片
