Case report
Progression of graft-versus-host disease in a patient after bone marrow transplantation due to chronic myeloblastic leukaemia – case report

Graft versus host disease (GVHD) is one of the most common complications observed after bone marrow and inner organ transplantations or after transfusions of blood and its products. GVHD is caused by immunocompetent lymphocytes contained in the transplanted tissue, due to the ability of lymphocytes to proliferate and then to attack the organs of the host. There are two forms of graft versus host disease: acute GVHD, when symptoms appear after about 3 weeks after transplantation, and chronic GVHD, with symptoms emerging later than 3 months after the procedure. Both acute and chronic GVHD present very diverse and atypical skin lesions, which may be very significant symptoms of the disease. Morphea-like skin lesions are the most typical signs of GVHD. The similarities between GVHD and lichen planus have recently been pointed out. We report a case of a patient with poikiloderma, as the symptom of GVHD. Skin lesions were the only sign of acute GVHD, and appeared 3 weeks after bone marrow transplantation due to chronic myeloblastic leukaemia. The patient was admitted to hospital in 2005 – at that time topical treatment was sufficient. In 2007 the patient was admitted to hospital with generalized scleroderma which caused him huge troubles in normal living. After haematological consultation the patient was started on PUVA therapy. This paper presents the evolution of skin lesions in the patient described above, which in a short period of time led to his serious disability.