Numerous Spider Angiomas as the Presenting Sign of Acute Graft Versus Host Disease

Abstract

Graft versus host disease (GVHD) is a highly morbid immunologic reaction and complication commonly seen in response to allogenic hematopoietic stem cell transplant. The underlying pathophysiology of this reaction is due to donor T-lymphocyte migration and activation of the host’s innate immune system. Quality of life is significantly impacted in these patients, particularly in those with chronic GVHD. GVHD may impact multiple organ systems, however, cutaneous involvement is the most common finding and is often the initial presenting sign. The clinical manifestations of cutaneous GVHD are highly variable, with many morphologies mimicking another skin condition.  We present a rare case of a 51-year-old male, who presented with multiple spider hemangiomas over the chest and back and a history of allogenic stem cell transplant and no history of liver disease, who was diagnosed with acute GVHD.