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Sep 2011

Dermatomal Sclerodermoid Graft-vs-Host Disease Following Varicella-Zoster Virus Infection

Author Affiliations

Author Affiliations: Department of Dermatology, Duke University Medical Center, Durham, North Carolina.

Arch Dermatol. 2011;147(9):1122-1123. doi:10.1001/archdermatol.2011.256

A 47-year-old white man with polycythemia vera underwent peripheral blood stem cell transplant from his HLA-matched brother in July 2004 and within 3 weeks developed histologically proven graft-vs-host disease (GVHD) of the chest and back. He was treated over the next 2 years with cyclosporine, prednisone, and triamcinolone, 0.1%, cream. His skin was maintained between a grade 0 and grade 1 acute GVHD, with multiple skin biopsy specimens showing histologic grade 1 and 2 disease, despite tapering doses of immunosuppressants. Oral mucosal and conjunctival involvement was minimal, and the patient's upper extremities were within normal limits. In July 2006, prophylactic acyclovir therapy was discontinued because the patient's treatment with immunosuppressant medications had been tapered off, and he had demonstrated positive IgG titer for varicella. Four months later, he was clinically diagnosed as having varicella-zoster virus (VZV) and treated with a 4-week course of acyclovir, 800 mg, 5 times a day, with complete resolution.