Graft-versus-host reaction. Cutaneous manifestations following bone marrow transplantation.
Graft-versus-host reaction. Cutaneous manifestations following bone marrow transplantation.
复制标题
移植物抗宿主反应。
作者：
A. Hood;N. Soter;J. Rappeport;I. Gigli
两名活体患者在因再生障碍性贫血进行骨髓移植后出现 GVHR，描述了急性和慢性移植物抗宿主反应 (GVHR) 中发生的独特皮肤变化。在皮肤中，急性 GVHR 的轻度形式被认为是细微的黄斑红斑，而严重的形式则表现为红斑丘疹和有鳞屑的紫罗兰色斑疹。两种急性形式的皮肤活检标本均显示表皮基底细胞层出现空泡改变，并伴有淋巴细胞浸润。慢性 GVHR 从广泛的鳞屑演变为弥漫性的皮肤硬化和萎缩区域，并伴有奇怪的网状色素沉着过度、溃疡和脱发。组织病理学研究表明真皮胶原化可能与临床硬皮样变化相关。由于其可见性，皮肤为 GVHR 的早期识别提供了独特的机会。
The distinctive cutaneous changes that occur in both the acute and chronic forms of the graft-vs-host reaction (GVHR) are described in two living patients in whom the GVHR developed after bone marrow transplantation for aplastic anemia. In the skin, the mild form of the acute GVHR is recognized as a subtle macular erythema, and the severe form appears as erythematous papules and violaceous macules with scale. Skin biopsy specimens in both of the acute forms show vacuolar alterations of the epidermal basal-cell layer with a perivenular infiltrate of lymphocytes. The chronic GVHR evolves from generalized scaling to diffuse areas of aclerotic and atrophic skin with a curious reticulated hyperpigmentation, ulcerations, and alopecia. Histopathologic study shows collagenization of the dermis that can be correlated with the clinical sclerodermoid changes. Owing to its visibility, the skin offers a unique opportunity for the early recognition of the GVHR.