Psoriasiform Graft-Versus-Host Disease: Report and Brief Review of the Literature

Abstract

Graft-versus-host disease (GVHD) is the primary cause of morbidity and non-relapse-related mortality after hematopoietic stem cell transplantation. GVHD is classically divided into acute and chronic forms; acute cutaneous GVHD presents as a morbilliform eruption, whereas chronic cutaneous GVHD presents with lichen planus-like or sclerodermoid morphology. Psoriasiform GVHD is a rarely described subtype that is challenging to distinguish clinically from psoriasis. In addition to classic psoriasiform histologic findings, demonstration of an often subtle vacuolar interface dermatitis and lymphocyte satellitosis are helpful for discrimination. Herein, the authors describe psoriasiform GVHD and review the clinicopathologic findings of this unusual variant. With the appropriate clinical findings, psoriasiform GVHD should be considered in the histologic differential diagnosis of a mixed tissue reaction pattern with both psoriasiform and interface changes.

Scaly plaques in a post‐hematopoeitic stem cell transplant patient

“…However, it appears later than 100 days post-transplant. 4 Histopathology shows similar findings to acute GVHD.…”

“…5 GVHD is a major cause of morbidity and mortality in patients receiving HSCT, and the skin is the most commonly affected organ. 2,4,[6][7][8] GVHD is currently classified according to its clinical and histopathological features and is divided into subcategories: classic, persistent, recurrent, or late onset acute GVHD; classic chronic; and overlap syndrome. 5 The typical cutaneous manifestations of acute GVHD are erythematous morbilliform eruptions, follicular erythema, or toxic epidermal necrolysis-like eruptions.…”

The mixed spongiotic and interface reaction pattern: A study of clinical and histopathologic findings

“…Because GvHD can present with a wide variety of histopathologic patterns, including psoriasiform, interface, and eczematous, clinical-histopathologic correlation is paramount. 21,22 Few significant differences were found between the clinical and histopathologic features of CADR and non-CADR cases. Spongiotic vesicles and intraepidermal Langerhans cells were both more common in non-drug eruptions (p = 0.04).…”

“…Because GvHD can present with a wide variety of histopathologic patterns, including psoriasiform, interface, and eczematous, clinical‐histopathologic correlation is paramount. 21 , 22 …”

“…Differentiating between GvHD and CADR was challenging because 10 patients (20%) had undergone BMT within 90 days of presentation. Because GvHD can present with a wide variety of histopathologic patterns, including psoriasiform, interface, and eczematous, clinical‐histopathologic correlation is paramount 21,22 …”