Sclerodermatous Graft-Versus-Host Disease Limited to an Area of Measles Exanthem

Fenyk, John R.; Warkentin, Phyllis I.; Goltz, Robert W.; Nesbit, Mark E.; Coccia, Peter F.; Smith, Clark M.; Krivit, William; Neely, John E.; Ramsay, Norma K.C.; Kersey, John H.

doi:10.1016/s0140-6736(78)90136-8

Cited by 44 publications

(9 citation statements)

References 3 publications

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“…Viral infections may precipitate skin GVHD, which has been described in a bone marrow recipient who contracted measles. 13 We believe that the rash and conjunctivitis were not manifestations of measles because the skin biopsy obtained soon after rash onset was consistent histologically with GVHD, and immunohistochemistry and RT-PCR both were negative for measles virus. We also doubt that the stem cell donor was the source of measles infection as she had no history of measles-like infection or travel to an endemic area, and RT-PCR on the donor stem cells was negative for measles.…”

Section: Discussionmentioning

confidence: 80%

A New Complication of Stem Cell Transplantation: Measles Inclusion Body Encephalitis

Freeman¹,

Jacobsohn²,

Shulman³

et al. 2004

Pediatrics

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ABSTRACT. Measles inclusion body encephalitis (MIBE) is a disease of the immunocompromised host and typically occurs within 1 year of acute measles infection or vaccination. We report a 13-year-old boy who had chronic granulomatous disease and presented 38 days after stem cell transplantation with afebrile focal seizures that progressed despite multiple anticonvulsants. After an extensive diagnostic evaluation, brain biopsy was performed, revealing numerous intranuclear inclusion bodies consistent with paramyxovirus nucleocapsids. Measles studies including reverse transcriptasepolymerase chain reaction and viral growth confirmed measles virus, genotype D3. Immunohistochemistry was positive for measles nucleoprotein. Despite intravenous ribavirin therapy, the patient died. MIBE has not been described in stem cell recipients but is a disease of immunocompromised hosts and typically occurs within 1 year of measles infection, exposure, or vaccination. Our case is unusual as neither the patient nor the stem cell donor had apparent recent measles exposure or vaccination, and neither had recent travel to measles-endemic regions. The patient had an erythematous rash several weeks before the neurologic symptoms; however, skin biopsy was consistent with graft-versus-host disease, and immunohistochemistry studies for measles nucleoprotein were negative. As measles genotype D3 has not been seen in areas where the child lived since his early childhood, the possibility of an unusually long latency period between initial measles infection and MIBE is raised. In addition, this case demonstrates the utility of brain biopsy in the diagnosis of encephalitis of unknown cause in the immunocompromised host. I n addition to acute encephalitis and subacute sclerosing panencephalitis in immunocompetent hosts, measles virus can cause measles inclusion body encephalitis (MIBE) in immunocompromised hosts. 1,2 MIBE presents typically with focal and intractable seizures within 1 year of initial measles infection. The mortality rate is high, and no effective treatment exists. 3 We report a patient who had chronic granulomatous disease (CGD) and developed fatal MIBE after nonmyeloablative cytoreduction and allogeneic stem cell transplantation (SCT). There was no history of recent or remote measles infection or exposure. CASE REPORTSThe patient was a 13-year-old Mexican-American boy who received a diagnosis of X-linked CGD at 2 years of age after serratia lymphadenitis. The patient was born in the United States and lived in Chicago but traveled frequently to urban Mexico, most recently 4 years before this illness. He received 1 documented measles-mumps-rubella vaccine at one year of age, and had no history of a measles-like illness or measles exposure at any time. A second measles-mumps-rubella vaccine was not documented. Despite prophylactic therapy for CGD with trimethoprim-sulfamethoxazole and thrice-weekly ␥-interferon, he had multiple staphylococcal liver abscesses that required extensive surgical drainage. Poor compliance with interferon ...

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Section: Discussionmentioning

confidence: 80%

A New Complication of Stem Cell Transplantation: Measles Inclusion Body Encephalitis

Freeman¹,

Jacobsohn²,

Shulman³

et al. 2004

Pediatrics

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“…Skin which is damaged by either aGVHD, sun, or herpetic infections seems to be more susceptible to being involved by the cGVHD process, and there have also been reports of cGVHD occurring in an area previously affected by the rash of measles, 4 and also of GVHD occurring only in areas of skin which had been exposed to irradiation, 5,6 or of it being exacerbated by radiation therapy. 7 Since in many respects, cGVHD mimics connective tissue disorders, and manifests with lichenoid and sclerotic changes in skin, muscle, tendons and ligaments, it seems likely that this patient's problem arose as a consequence of a relatively localised lichenoid manifestation of cGVHD which may have been exacerbated by the total body irradiation that she received as part of her conditioning therapy, in conjunction with post-menopausal vaginal dryness and atrophy coupled with loss of vaginal glandular tissue.…”

Section: Discussionmentioning

confidence: 99%

Vaginal stenosis following allogeneic bone marrow transplantation for acute myeloid leukaemia

Treleaven

Shepherd

et al. 1999

Bone Marrow Transplant

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Summary:We report the unusual complication of vaginal stenosis occurring after allogeneic bone marrow transplantation (BMT) for leukaemia. This was in all likelihood a manifestation of chronic graft-versus-host disease (cGVHD), although the patient has no other stigmata of this and suffered little acute graft-versus-host disease (aGVHD) after BMT. Other risk factors for vaginal stenosis were considered and appear to be absent in this patient, although the total body irradiation used as part of her conditioning therapy may play a role. We suggest that vaginal stenosis may be under-reported, since female patients suffer a number of gynaecological complications after BMT, and that regular questioning and examination may aid in making an earlier diagnosis, allowing speedier instigation of therapy and thus improving quality of life.

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“…The patient developed measles 7 months post-transplant and the viral exanthema resolved over 3 weeks. However, within the next 2 months, poikiloderma and sclerotic-type chronic GVHD appeared in the same areas as her acute measles viral exanthem [26]. …”

Section: Discussionmentioning

confidence: 99%

Isomorphic Sclerotic-Type Cutaneous Chronic Graft-Versus-Host Disease: Report and Review of Chronic Graft-Versus-Host Disease in a Cutaneous Immunocompromised District

Cohen

2013

Dermatol Ther (Heidelb)

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BackgroundPatients who have received a hematopoietic cell transplantation can develop graft-versus-host disease (GVHD). The liver, the gastrointestinal tract, and/or the skin can be affected by GVHD. Chronic sclerotic-type cutaneous GVHD can occur at sites of repetitive skin friction.PurposeTo describe isomorphic sclerotic-type GVHD and review chronic GVHD appearing in a cutaneous immunocompromised district.MethodsThe clinical features of a 74-year-old man with mantle cell lymphoma who developed chronic sclerotic-type cutaneous GVHD localized to the waistband area—which had been exposed to repetitive skin injury—after a second hematopoietic cell transplantation are reported. Using the PubMed database, an extensive literature search was performed on chronic GVHD.Case report and reviewThe cutaneous immunocompromised district is an area of skin whose local effective immunity has been altered, thereby permitting the development of a dysimmune reaction, infection, or tumor at the site. A cutaneous isomorphic response refers to a disease-associated skin lesion occurring at the site of physical injury that is morphologically similar to the existing condition. Cutaneous chronic GVHD can occur at sites of repetitive skin trauma as an isomorphic response. The patient developed sclerotic-type GVHD in a cutaneous area that had previously experienced repeated irritation, friction, and pressure. Isomorphic sclerotic-type GVHD—in either the waistband area or brassiere area or both—has also been observed in other patients. In addition, cutaneous chronic GVHD has been described not only at the location of a previous, unrelated, and healed skin disease as an isotopic response, but also at the cutaneous site of earlier exposure to radiotherapy or ultraviolet radiation as an isoradiotopic response.ConclusionSclerotic and nonsclerotic skin lesions of chronic GVHD can occur not only as an isomorphic response, but also as either an isotopic response or an isoradiotopic response in a cutaneous immunocompromised district.

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Sclerodermatous Graft-Versus-Host Disease Limited to an Area of Measles Exanthem

Cited by 44 publications

References 3 publications

A New Complication of Stem Cell Transplantation: Measles Inclusion Body Encephalitis

A New Complication of Stem Cell Transplantation: Measles Inclusion Body Encephalitis

Vaginal stenosis following allogeneic bone marrow transplantation for acute myeloid leukaemia

Isomorphic Sclerotic-Type Cutaneous Chronic Graft-Versus-Host Disease: Report and Review of Chronic Graft-Versus-Host Disease in a Cutaneous Immunocompromised District

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