Endocrine Abstracts

Graft vs host disease is a disorder in which the graft, i.e. bone marrow, attacks the host after bone marrow transplantation. It has various manifestations, one being skin and muscle involvement with cutaneous sclerosis and diffuse muscle pain. The aim was to describe the case of a patient with graft vs host disease complicated by insulin resistance and metabolic syndrome, after bone marrow transplantation for the treatment of acute lymphoblastic leukemia.

A patient, male, aged 2.5 years old, developed acute lymphoblastic leukemia. He was treated and the disease went into remission. At the age of 7 years, the patient had a recurrence. He was found to be compatible with his elder brother and bone marrow transplantation was performed. During the following months the patient developed a skin eruption, diffuse cutaneous sclerotic lesions, muscle edema and pain.

He was treated with thalidomide and cyclosporine and clinical manifestations of graft vs host disease improved. Diffuse skin and muscle involvement improved. The patient developed hypertriglyceridemia and insulin resistance. Metformin and fenofibrate were administered. The patient developed also hypothyroidism. Thyroxine was administered. At the age of 29 the patient developed psoriasis like lesions in the maxilla and the external genital organs.

In conclusion, the case of a patient is described with graft vs host disease after bone marrow transplantation for the management of acute lymphoblastic leukemia. Graft vs host disease may have various clinical manifestations. In the case described skin and muscle involvement, along with insulin resistance and metabolic syndrome were the predominant manifestations.