Background: Graft-versus-host disease (GvHD) remains the major toxicity of allogeneic bone marrow transplantation (BMT). In the acute form of the disease, the differential diagnosis includes viral rash and drug eruptions. Methods: We report two patients with chronic myeloid leukemia submitted to allogeneic BMT who developed a severe form of acute cutaneous GvHD, with clinical and histological pictures mimicking toxic epidermal necrolysis (TEN). Results: We found a predominance of peripheral CD8+ T lymphocytes and, at the same time, studying the cellular profile of the blister fluid, just in the beginning of blister eruption, we also found a high proportion of CD8+ T lymphocytes, mainly CD8+CD57–. Conclusion: These data are in agreement with previous reports of the presence of CD8+ T cells in the blister fluid of patients with TEN, further emphasizing similar immunoinflammatory pathways in both diseases.

Summary:Tuberculosis is an uncommon infectious complication after stem cell transplantation. We report a patient who presented with a brain mass, 3 months after pulmonary tuberculosis had been diagnosed and while he was receiving triple antituberculous therapy. He had extensive chronic GVHD. The diagnosis was made after biopsy of the lesion. The cerebral mass was excised, antituberculous treatment was maintained and the patient made a complete neurologic recovery. Six months later, he died of gram-negative septic shock. Mycobacterial infections should be considered in allograft recipients with chronic GVHD and solid lesions in the brain. Bone Marrow Transplantation (2000) 25, 567-569. Keywords: stem cell transplantation; graft-versus-host disease; tuberculosis Tuberculosis remains a major problem in the world today. It is estimated that one third of the world population is infected with Mycobacterium tuberculosis, with more than eight million new cases and nearly three million deaths occurring each year.1 Tuberculosis is directly responsible for 7% of all deaths world-wide, and the global pandemic is likely to worsen as a result of the spread of drug-resistant organisms and the ongoing human immune-deficiency virus (HIV) epidemic.2 Stem cell transplant recipients have severely impaired cell-mediated immunity as a result of their underlying disease, pre-transplant chemotherapy and radiation, graft-versus-host disease (GVHD) and its treatment. Considering mycobacteria epidemiology characteristics and the severe immune-suppression after stem cell transplantation, a high incidence of mycobacterial infections would be expected. However, this infection is uncommon, even in endemic areas, and the literature is relatively sparse concerning this subject. 3,4