Chronic graft versus host disease: a scleroderma-like case report

INTRODUCTION: Chronic graft versus host disease (cGVHD) is the most common consequence of allogeneic bone marrow transplantation, and it is associated with morbidity and mortality. Oral manifestations are diagnosed in approximately 80 percent of patients with chronic GVHD. OBJECTIVE: To present a case of chronic GVHD with scleroderma-like lesions in skin and oral cavity CASE REPORT: A 27-year-old female was admitted, in a Hematology Center, in 1997, with previous diagnosis of chronic myeloid leukemia since 1994. Over past four months after allogeneic BTM she developed cGVHD in eyes, mouth, liver, lungs and skin. The patient presented sclerotic skin changes, hyperkeratosis of hands and xerophthalmia. CONCLUSION: Clinical manifestations of chronic GVHD are similar to autoimmune collagen vascular disease and the two main types of cutaneous chronic GVHD are lichenoid and sclerodermatous.

Diretrizes para o diagnóstico, classificação, profilaxia e tratamento da doença enxerto contra hospedeiro crônica / Guidelines for the diagnosis, classification, prophylaxis and treatment of chronic graft-versus-host disease

A falta de critérios diagnósticos padronizados, amplamente utilizados, pode comprometer tanto a avaliação real da incidência da doença contra hospedeiro crônica bem como a correlação de sua gravidade com a taxa de mortalidade pós-transplante. Na I Reunião de Diretrizes da Sociedade Brasileira de Transplante de Medula Óssea, realizada em junho de 2009, o Grupo de Estudos de DECH Brasil - Seattle (GEDECH), baseado na realidade dos Centros brasileiros, apresentou as recomendações para diagnóstico, classificação, profilaxia e tratamento da doença enxerto contra hospedeiro crônica propostas pelo National Institutes of Health. Estas propostas incluíram padronização das características utilizadas no diagnóstico e ferramentas para a pontuação dos órgãos envolvidos e avaliação global da gravidade a serem utilizados em estudos clínicos da doença enxerto contra hospedeiro crônica. Estes critérios são úteis para uma melhor análise da incidência desta doença, além de poder avaliar a gravidade do comprometimento de um órgão ou sítio envolvido e a influência na mortalidade tardia do transplante. A profilaxia e os tratamentos propostos para esta importante complicação dos transplantes de células-tronco hematopoéticas foram discutidos e graduados de acordo com níveis de evidência estabelecidos pelo National Institutes of Health.

The lack of widely-used standardized diagnostic criteria may impair both the true evaluation of chronic graft-versus-host disease and the correlation of its severity with transplant-related mortality. At the I Consensus of the Brazilian Society of Bone Marrow Transplantation - SBTMO that took place in June 2009, the Group of GVHD Studies Brazil-Seattle (GEDECH), presented the guidelines for diagnosis, classification, prophylaxis and treatment of chronic GVHD as proposed by the National Institutes of Health and based on the reality in Brazilian Centers. These proposals, including standardization of features used in diagnosis and tools to score involved organs and to assess the overall severity, should be used in clinical studies of chronic graft-versus-host disease. These criteria are useful to better analyze the incidence of this disease, in addition to evaluate the extension of the involvement of organs or the site affected and its influence on late transplantation mortality. Prophylaxis and treatment proposed for this important complication of hematopoietic stem cell transplantations were discussed and graded according to the levels of evidence established by the National Institutes of Health.

Oral HPV infection in a bone marrow transplantation patient: a case report with atypical clinical presentation and unexpected outcome

HPV (Human Papilloma Virus) is one of the most prevalent infections worlwide. Oral HPV infection may be associated with different diseases of oral cavitie. Although oral HPV infection occurs frequently, it rarely causes lesions. An increased rate of oral HPV-induced lesions is observed in people with an impaired immune system. The most common conditions induced by oral HPV infection are focal epithelial hyperplasia, oral condylomas and oral papillomas. We reported a case of oral HPV lesion in a bone marrow transplantation patient with atypical clinical presentation and unexpected outcome.

Herpetic geometric glossitis: Acyclovir resistant case in a patient with acute myelogenous leukemia.

Herpes simplex virus (HSV) infections in an immunocompromised host may be atypical in location and morphology. Lesions are more extensive and aggressive, slow healing or nonhealing and extremely painful. Intraoral lesions are ulcerative and may involve any intraoral, oropharyngeal, or esophageal site. Herpetic geometric glossitis is a recently described form of lingual HSV infection in an immunocompromised patient. It was described as ulcer on the dorsum of the tongue sensitive for acyclovir therapy. A patient is presented with acute myelogenous leukemia that developed herpetic geometric glossitis which was acyclovir resistant.