Abstract
We report a 4-year-old boy with fasciitis of musculus platysma as a manifestation of chronic graft-versus-host disease (GVHD). He underwent allogeneic bone marrow transplantation from an HLA 1-locus mismatched mother for myelodysplastic syndrome. The prophylaxis for his acute GVHD consisted of short-term methotrexate and cyclosporin A. On day 72, he developed thrombocytopenia and liver dysfunction corresponding to grade II acute GVHD. These findings resolved in response to prednisolone and tacrolimus, which were discontinued on day 139. However, bilateral neck swelling, generalized skin rash, and photophobia with keratoconjunctivitis sicca developed on day 182. Laboratory examination revealed eosinophilia, liver dysfunction, and elevation of serum aldolase. A T2-weighted MR image showed hyperintensity of the fasciae of bilateral musculus platysma and the surrounding subcutaneous tissue. A full-thickness skin-muscle-fascia biopsy taken from the right leg showed chronic GVHD and early signs of fasciitis. After treatment with prednisolone and tacrolimus, the patient's skin rash, eosinophilia, and liver dysfunction rapidly disappeared, and the fasciitis of musculus platysma improved four months later. This is the first case report of fasciitis developing on the neck as a manifestation of chronic GVHD.
