Abstract

Acute Graft-Versus-Host Disease (GVHD) typically presents with morbilliform eruptions, while chronic GVHD is associated with sclerodermoid or lichen-planus-like manifestations. Psoriasiform GVHD is a rarely encountered chronic subtype and is often difficult to clinically distinguish from psoriasis. Our patient is an 81-year-old male with a past medical history of myelodysplastic syndrome status-post allograft peripheral stem cell transplant 1.5 years ago complicated by chronic lichen planus variant GVHD to arms, back, and chest. He presented with development of a new, worsening rash to the suprapubic region, groin, and axilla. The rash was not pruritic or painful. On physical examination, scattered erythematous ovoid and round papules and thin plaques were noted to the bilateral arms, chest, abdomen, bilateral axilla, suprapubis and groin, and less notably to the scalp, neck, back, and thighs. Fine, overlying scaling was present in the suprapubic region. Punch biopsy of the suprapubic region revealed psoriasiform acanthosis and mild spongiosis with rare necrotic keratinocytes strongly favoring psoriasiform GVHD. This represents an atypical case of a patient with known lichen planus-like GVHD who developed superimposed psoriasiform GVHD with progression of his disease. This case expands the spectrum of clinical and histologic changes that can occur in GVHD. In the right clinical setting, psoriasiform GVHD should be strongly considered over other causes of this morphology.

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