A follicular lichenoid eruption as manifestation of chronic graft-vs-host disease.

A33-year-oldwomanwith refractory anaemiawith excess of blasts underwent anHLA-matched allogeneic bonemarrow transplantation following preparation with busulfan and cyclophosphamide. She also received methotrexate, on days z1, 3, 6 and 11 and cyclosporin A. Marrow engraftment was achieved successfully on day z27. On day 87 after the bone marrow transplantation, an erythematous-to-violaceous, predominantly follicular, lichenoid papular eruption developed on the anterior thorax, back, arms and thighs (Fig. 1). In addition, numerous erythematous papules were present on the palmar surfaces of the hands, and reticulate white, occasionally erosive lesions were observed on the surface of the buccal mucosae. The patient had diarrhoea with 4 to 5 loose watery stools a day. Histological examination of a follicular papule on the thigh revealed basal-cell vacuolization with dyskeratosis in the basal layer of the follicular epithelium as well as the interfollicular epidermis. A sparse perivascular and perifollicular lymphocytic in¢ltrate was observed in the upper dermis, with occasional exocytosis into the follicular epithelium. A biopsy specimen of a papular lesion on the palm showed similar ¢ndings except for the follicular involvement. No alterations were found in the laboratory studies. The ¢ndings were interpreted as grade 2 chronic GVHD, and therapy was started with systemic corticosteroids. The diarrhoea ceased promptly and the cutaneous lesions resolved in the following weeks, but the erosive lesions of lichenoid GVHD in the buccal mucosae were more recalcitrant and resolved more slowly in several months. After 5 years of follow-up, the patient is doing well.