A 53-year-old woman with worsening rash and diarrhea

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Vol: 7, Issue: 1

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Kavanaugh, MD, Bryan
A 53-year-old woman; worsening rash; diarrhea; thomas jefferson university; the medicine forum; internal medicine; philadelphia; Medicine and Health Sciences
case description
A 53-year-old white female was admitted to the Bone Marrow Transplant Unit with a worsening pruritic rash.The patient had a history of IgG lambda multiple myeloma status post autologous stem cell transplant one year prior and more recently, matched sibling allogenic transplant. Since transplantation, she had a history of rash, which was diagnosed as graft-versus-host disease (GVHD) by skin biopsy. During that same hospitalization, she had a transjugular liver biopsy to rule out GVHD which was complicated by a large intrahepatic and subcapsular hematoma. A catheter to drain the hematoma was placed by interventional radiology, which was still in place. The patient was discharged following her allogenic transplant with successful engraftment of donor stem cells on bone marrow biopsy, without evidence of residual multiple myeloma. She was on GVHD therapy with tacrolimus, prednisone, and Cellcept. Recently, her rash had returned and was becoming increasingly pruritic over several weeks prior to admission.