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Chronic graft‐versus‐host disease of the male genitalia: an underrecognized manifestation

We report the case of a 24-year-old man who presented with asymptomatic, lichenoid penile lesions involving the proximal part of the glans and extending to the coronal sulcus. The patient had a history of hypoplastic myelodysplasia (JAK2 mutation) with monosomy of chromosome 7 for which he had undergone allogeneic hematopoietic stem cell transplantation (HSCT) 16 months earlier. One week after the transplant, he had developed mild cutaneous graft-versus-host disease (GVHD), (acute cutaneous GVHD: stage 3, grade II). Five months later, a lichen planus-like ulceration of the oral cavity had appeared (Figure 1 a). A biopsy of the oral lesion confi rmed the diagnosis of lichenoid chronic GVHD (cGVHD). Since the transplantation, the patient had been on cyclosporine, prednisone, foscarnet, misoprostol, trimethoprim sulfamethoxazole, fl uconazole, and pantoprazole. Treatment of the aforementioned oral lesion included clobetasol cream (one application daily), tacrolimus 0.1 % ointment (dermal application), and narrowband UVB therapy, which resulted in disease stabilization. After six months, the oral lesion had healed with hyperpigmentation. Sixteen months after the transplantation, the patient developed lichenoid lesions on the penis (Figure 1 b, c). Autoimmunity markers and markers for sexually transmitted infections were negative. A biopsy of the lesion revealed parakeratosis, compact orthokeratosis, focal hypergranulosis with few apoptotic keratinocytes, focal vacuolar degeneration along the dermoepidermal junction, and a mononuclear infi ltrate (lymphocytes and plasma cells) in the upper dermis just below the epidermis. The presence of parakeratosis, focal hypergranulosis, and a dense lichenoid infi ltrate was suggestive of cGVHD (Figure 2 a, b). Topical corticosteroids (clobetasol cream, one application daily) were added to the immunosuppressive therapy. After two weeks, the lichenoid ulceration of the penis had disappeared and topical therapy was discontinued by gradually reducing the frequency of application. Since then, no relapse has occurred.