Sclerodermatous Graft-Versus-Host Disease-Related Angiomatosis

Abstract

Chronic graft-versus-host disease (cGVHD) is a relatively common complication of allogenic hematopoietic stem cell transplantation, although the exact incidence is unknown. The disease most commonly affects the skin, liver, and gastrointestinal tract, but any organ may be involved. Cutaneous manifestations are varied and rarely include vascular eruptions now characterized by the term “graft-versus-host disease associated angiomatosis” (GVHD-AA). We present a 70 year-old male with bleeding violaceous plaques and papules in the setting of sclerodermatous cGVHD. Biopsy of these lesions revealed angiomas with focal organizing thrombosis in a background of marked dermal sclerosis. Ulceration and progression of lesions continued despite treatment with local excision, prednisone, extracorporeal photopheresis, and hydroxychloroquine. GVHD-AA likely represents reactive vascular proliferation in areas of dermal sclerosis.1 We report this case to raise awareness of GVHD-AA as a potential diagnosis in patients who present with vascular eruptions in the setting of cGVHD, and to encourage research into the etiology and potential treatment of reactive angiomatosis.