A white woman in her 60s presented for a routine visit to the outpatient dermatological graft-vs-host disease (GVHD) clinic at Westmead Hospital for review of lichenoid GVHD evolving into sclerodermatous GVHD. The GVHD occurred secondary to a bone marrow transplant in 2014 for treatment of chronic lymphocytic leukemia. At the time of review she was being treated with oral azathioprine (50 mg twice daily), tacrolimus (0.5 mg twice daily), and prednisone (25 mg daily) therapy. She was also receiving monthly intravenous immunoglobulin, prophylactic oral fluconazole, acyclovir, sulfamethoxazole-trimethoprim, and penicillin. One month prior to commencing oral azathioprine therapy, the patient noted the growth of nodules on the genital and perianal region, with 1 ulcerated nodule in the perianal area associated with painless bleeding on trauma. The lesions were otherwise asymptomatic.
Nguyen Y, Chou S, Fernandez-Peñas P. Cutaneous Nodules in the Genital Area in a Patient With Chronic Graft-vs-Host Disease. JAMA Dermatol. 2017;153(5):465–466. doi:10.1001/jamadermatol.2016.5657
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