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|Videos|April 24, 2020
A 61-Year-Old Man With Acute Graft-Versus-Host Disease
Author(s)Usama Gergis, MD
Usama Gergis, MD, presents the case of a 61-year old man with GvHD, and provides an overview of available treatment options for similar patients, with consideration of the REACH1, REACH2, and GRAVITAS-301 trial regimens.
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Case Overview:
Initial presentation
- A 61-year old man presented with a generalized pruritic rash, abdominal pain and diarrhea (8-12 BMs/day)
- PMH: he underwent haploidentical allogeneic hematopoietic-cell transplantation for AML 40 days ago
- PE: maculopapular erythematous rash on bilateral palms, cheeks, ears and upper back (rash involvement >50% of skin); abdomen is tender to palpation diffusely
Clinical workup
- Labs: ANC 0.7 x 109/L, plt 75 x 109/L, total bilirubin 8 mg/dl, AST 54 U/L, ALT 60 U/L
- Negative for HBV, HBV, CMV, EBV, HHV-6
- Negative stool tests
- Flexible sigmoidoscopy with biopsy:
- Lower GI biopsy showed moderate mixed inflammation in the lamina propria and scattered apoptotic bodies without crypt loss
- Skin punch biopsy of the back shows hyperkeratosis, hypergranulosis associated with lichenoid inflammatory infiltrate
- Modified Glucksberg criteria: grade 3; MAGIC criteria: grade III
Treatment
- Systemic corticosteroids (prednisone 2 mg/kg/day) + topical steroids (triamcinolone)
- No treatment response after day 5
- He was started on ruxolitinib 5 mg PO BID, increased to 10 mg PO BID on day 6
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