Severe chronic graft-versus-host disease of the fasciae and muscles of the hand—Case report

Abstract

Chronic graft-versus-host disease (cGVHD) is very common after allogeneic hematopoietic cell transplantation with an incidence of 20–80%. It can occur at variable intervals after allogeneic transplantation in any organ containing lymphoid cells. Mucocutaneous manifestations of cGVHD are the most frequent with variable manifestations, followed by involvement of the gastrointestinal tract, liver and lung. Musculocutaneous cGVHD presents with connective tissue changes that may resemble eosinophilic fasciitis or systemic collagen vascular diseases such as scleroderma, dermatomyositis or systemic lupus erythematosus. The musculocutaneous changes are associated with serious physical and functional impairment which can lead to considerable impairment of patient's quality of life. As magnetic resonance imaging allows for more detailed assessment of extent and activity of the inflammatory infiltration in the deep soft tissue, it may contribute to early diagnosis and staging and allow for adequate treatment with systemic immunosuppressants. We report about a rare manifestation of musculocutaneous chronic graft-versus-host disease (cGVHD) in a 74-year-old female patient who developed severe musculocutaneous symptoms of the hand after allogeneic hematopoietic cell transplantation for treatment of acute myeloblastic leukaemia. Based on this case, typical clinical and morphological features of musculocutaneous cGVHD are discussed and the potential role of magnetic resonance imaging in the assessment of the severity of the musculocutaneous involvement is shown. Awareness of possible musculocutaneous manifestation of cGVHD may be helpful for radiologists in identifying patients presenting with similar symptoms and image findings after allogeneic hematopoietic cell transplantation in order to provide early and adequate treatment. Moreover, magnetic resonance imaging may offer an objective and reproducible measuring tool in the evaluation of treatment response because this imaging technique provides reliable assessment of depth, infiltration and activity of the disease.