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Ruud Valks, MD, PhD; Jesús Fernández-Herrera, MD, PhD; Beatriz Bartolomé, MD; Javier Fraga, MD, PhD; Esteban Daudén, MD, PhD; Amaro Garcia-Diéz, MD, PhD

Arch Dermatol. 2001;137:61-65.

Background  Graft-vs-host disease (GVHD) is divided into acute and chronic phases based on time and clinical and histological features. The criterion of 100 days after transplantation for separating acute GVHD from chronic GVHD has been challenged on the following points: (1) the lichenoid rash of chronic GVHD may be observed as early as day 31 and acute GVHD may persist after day 100 in some cases, and (2) specific histological features do not consistently separate acute from chronic GVHD defined as the number of days after transplantation. However, the appearance of acute cutaneous GVHD after day 100 is not well established.

Observations  Three patients developed a rash with clinical and histological features of acute GVHD between days 153 and 192 after allogeneic bone marrow transplantation or peripheral blood stem cell transplantation. In all patients, the late flare of acute GVHD occurred after tapering or suspending the immunosuppressive regimen with cyclosporine or corticosteroids, and was accompanied by stigmata of chronic GVHD in other target organs.

Conclusions  The rash of acute GVHD may be observed as late as 192 days after transplantation, especially after tapering or suspending the immunosuppressive drugs, and should be considered in the differential diagnosis of late erythematous eruptions after transplantation.

From the Departments of Dermatology (Drs Valks, Fernández-Herrera, Bartolomé, Daudén, and Garcia-Diéz) and Pathology (Dr Fraga), Hospital Universitario de la Princesa, Madrid, Spain.

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