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Case Reports
. 2020 Sep 19;11(6):988-990.
doi: 10.4103/idoj.IDOJ_87_20. eCollection 2020 Nov-Dec.

Follicular Graft Vs Host Reaction: A Rare Presentation

Deepak Vashisht  1 , Rohit Kothari  1 , Sukriti Baveja  1 , Shekhar Neema  1 , Prashant Sengupta  2 , Sunmeet Sandhu  1
Affiliations
Case Reports

Follicular Graft Vs Host Reaction: A Rare Presentation

Deepak Vashisht et al. Indian Dermatol Online J. .

Abstract

Graft versus host disease (GVHD) is a unique entity wherein the donated marrow cells (graft) view the hosts as foreign and attack various body organs. Skin is the most frequently affected organ followed by mucosa, eyes, gastrointestinal, respiratory, musculoskeletal system, and other organs. The incidence of GVHD varies from 25 to 80%. Cutaneous involvement can present as exanthem, epidermolysis, lichenoid eruptions, erythroderma, ichthyosis, pityriasis rubra pilaris like lesions, psoriasiform lesions or just pruritus. Asymptomatic truncal follicular eruptions as the major presentation is rare. We report a case of aplastic anemia that developed extensive truncal folliculocentric papules 10 months following an allogeneic hematopoietic stem cell transplantation. Histopathological examination of the follicular lesions revealed perifollicular inflammatory infiltrate comprising of lymphocytes, plasma cells and histiocytes at the dermo-epidermal junction. Basal cell vacuolization, pigment incontinence in the upper dermis and few apoptotic keratinocytes in the follicular epidermis were also seen. The patient responded satisfactorily to tapering doses of steroids.

Keywords: Graft versus host disease; hematopoietic stem cell transplant; lichenoid follicular papules.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Follicular GVHD (a) Higher magnification of the folliculocentric lichenoid papules over the back (Empty five-point star) (b) Dermoscopy (Illuco IDS-1100, 10×) of the follicular lesions over the trunk showed diffuse folliculocentric hyperpigmented pattern (Empty four-point stars)
Figure 2
Figure 2
Oral cavity showing an ill to well-defined violaceous pigmentation over the hard palate (Empty four-point star)
Figure 3
Figure 3
Histopathology of follicular GVHD (a): Perifollicular inflammatory infiltrate comprising of lymphocytes, plasma cells, histiocytes at the dermo-epidermal junction (Black empty arrow) and pigment incontinence in the upper dermis (Empty four-point star) (H & E, 40×) (b): Basal cell vacuolization (Empty four-point star), pigment incontinence (Empty black triangle) and few apoptotic keratinocytes in the follicular epidermis (H & E, 200×)
See this image and copyright information in PMC

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