Acute graft-versus-host-disease mimicking EAC: An atypical cutaneous presentation

Cutaneous manifestations of graft-versus-host-disease (GVHD) are seen in over 50% patients receiving hematopoietic cell transplant (HCT).1 There is a growing body of evidence that suggests cutaneous GVHD can mimic a wide range of other skin conditions. The case discussed is an 18-month old child with a background of primary immunodeficiency/dysregulation syndrome presented with a persistent rash arising one month following successful haematopoietic stem cell transplantation. The eruption consisted of multiple, slowly expanding annular, serpiginous and polycyclic plaques, with clear centres and fine trailing scale internal to the expanding edge. The appearances were clinically typical for erythema annulare centrifigum (EAC), yet three biopsies separated over a twelve-month period revealed features in keeping with cutaneous GVHD. During this time course, the child never developed typical hepatic or gastrointestinal manifestations of GVHD. The eruption was highly pruritic and treatment resistant. This case represents a diagnostic dilemma that requires further discussion with clinical images and histopathology provided.
1. Jagasia M, Arora M, Flowers ME, et al. Risk factors for acute GVHD and survival after hematopoietic cell transplantation. Blood. 2012; 119: 296-307.

Dr. Justin Bui

Department of Dermatology, Fiona Stanley Hospital, Murdoch, Western Australia

Justin is the dermatology resident at Fiona Stanley Hospital in Western Australia. He also the Chair of the Postgraduate Medical Council of Western Australia JMO Forum and recipient of the 2016 Junior Doctor of the Year Award for outstanding contribution to prevocational medical education