Clinical, Histological, and Immunohistological Studies of Postoperative Erythroderma

Abstract

We report 7 cases of acute fatal illness characterized by fever, diffuse erythematous rash, and progressive leukopenia occurring 10 days after surgical operation. The outcome was uniformly fatal. The biopsy findings consisted of eosinophilic individual necrosis of epidermal cells, satellite cell necrosis, basal liquefaction degeneration, and scanty cell infiltration into the dermis. T lymphocytes were found in the epidermis but Langerhans cells disappeared. These findings are compatible with acute graft-vs-host disease following blood transfusion. Explanations based upon drug allergy, infection, toxic shock syndrome, or toxic epidermal necrolysis seem less reasonable.

Erythroderma/exfoliative dermatitis: a synopsis

“…3), dermatophytosis, ichthyosiform erythroderma, crusted (Norwegian) scabies, graft‐vs.‐host disease, and irradiation 1,12,14,16,59,67–69 . Postoperative erythroderma, a type of graft‐vs.‐host disease appearing several days after surgery along with blood transfusion, is characterized by erythroderma, fever, pancytopenia, hepatic insufficiency, and diarrhea, and may prove fatal 21,22,70 . Exfoliative dermatitis may also develop during seroconversion in HIV‐infected patients with florid manifestations 23,24,71 …”

Scaling Lichenoid Eruptions and Sjögren‐like Syndrome: Manifestations of Nonfatal Postoperative Transfusion‐Associated Graft‐versus‐Host Disease?

“…It has been found that GVHD can occur in immunocompetent recipients who receive a blood transfusion during and/or after an operation (1)(2)(3)(4)(5). InJapan, this condition had been reported as "postoperative erythroderma" of unknown cause (6,7). This postoperative transfusion-associated GVHD (TA-GVHD) is characterized by fever, skin eruption, hepatic dysfunction, di-arrhea, and leukopenia with rapid deterioration, resulting in death around 10 to 20 days after the operation.…”