Transmission of psoriasis by allogeneic bone marrow transplantation and blood transfusion

Psoriasis is an immune-mediated dermatological disease, with T-cells have an important role in its pathogenesis. Activated CD4 and CD8 lymphocytes infiltrate the dermis and epidermis, resulting in hyperkeratosis, parakeratosis, epidermal acanthosis, elongation of the rete ridges and vascular dilatation. Before allogeneic bone marrow transplantation (BMT), the immune system of the host is effectively eliminated by a preconditioning regimen, and any immune response after BMT is typically of donor origin. In the past 25 years, 430 patients with psoriasis who underwent BMT and subsequently achieved long-term remission of psoriasis have been reported in the literature. Interestingly, patients who developed psoriasis following allogeneic BMT have also been reported, with three cases of acquired psoriasis after BMT from donors with psoriasis. We report two additional cases of patients who developed psoriasis after blood transfusion or allogeneic BMT. Case one: A 29-year-old woman was admitted for inpatient treatment on 20 August 2006. Three months before, the patient had received whole blood, due to postnatal hemorrhea, from a typeand Rh-matched donor who had a 10-year history of psoriasis vulgaris. The patient’s erythra was diffusely distributed, of unequal size, scaled and positive for Auspitz’s sign (Figure 1a). A biopsy of the lesion revealed a thick epidermis with the typical pattern and Munro–Sabouraud microabscesses (Figure 1b). On the basis of the clinical and biopsy data, the patient was diagnosed with psoriasis vulgaris. After 5 weeks of combined treatment with penicillin, sodium thiosulfate, vitamin B12 and folic acid, the lesions resolved. The patient has been psoriasis-free through August 2014. Case two: A 35-year-old man with ETO (runt-related transcription factor 1; translocated to, 1 (cyclin D-related)) fusion genepositive (t(8;21)(q22;q22)) acute myelogenous leukemia (AML) visited the dermatology outpatient clinic on 15 May 2014, complaining of a skin lesion. In October 2010, he had been diagnosed with AML-M2/ETO. Neither the patient nor his family suffered from psoriasis, and he was negative for HLA-B27. After treatment with hydroxyurea for 7 months, followed by conditioning therapy with busulfan and cyclophosphamide, BMT was performed from an HLA-matched donor, who had suffered from psoriasis for 410 years. The patient was treated with Bu/CY radiation before BMT (1238 ml of bone marrow containing CD34