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Gloves and Socks Syndrome after bone marrow transplantation

A 17-year-old male patient with relapsed T-cell acute lymphoblastic leukaemia (T-ALL) underwent matched sibling donor bone marrow transplantation (BMT) after myeloablative conditioning with total body irradiation (TBI) and etoposide. Haematological engraftment was achieved on day +15. Ciclosporin (3 mg/kg/d) and mycophenolate mofetil were given for immunosuppression, together with antibiotics and aciclovir for infectious prophylaxis. On day +14, he developed paresthesiae, oedema and erythema of the hands and feet followed by erythematous, papular lesions that spread centripetally. There were no signs of acute graft-versus-host disease (aGvHD) involving other organ systems. Weekly polymerase chain reaction (PCR) screening for viral infections, such as cytomegalovirus, Epstein–Barr virus, human herpesvirus 6 and parvovirus B19 in the peripheral blood remained negative. As aGvHD was a differential diagnosis, the patient received prednisolone 2 mg/kg/d from days +18 to +20. A biopsy of the plantar lesion was taken on day +21. Histology showed non-specific interface dermatitis with vacuolar degeneration and perivascular inflammatory infiltrates mostly composed of lymphocytes. PCR analysis identified repetitively high parvovirus B19 DNA content in the cutaneous biopsy specimen, still without signs of viremia. In the course of a week, the lesions cleared with palmar and plantar desquamation. In summary, these data argue for manifestation of a gloves and socks syndrome post-BMT caused by parvovirus B19, which may resemble clinical features of aGvHD because of immunological phenomena accompanying parvovirus B19 infection.