Clinical manifestation

Incidence higher in recipients of allogeneic hematopoietic cells than in patients receiving syngeneic or autologous hematopoietic

262 Granular bacteriosis cells; greatest incidence in patients in whom bone marrow is used as the source of hematopoietic cells

Acute graft versus host disease: observed 10-30 days posttransplant; eruptions usually begin as faint, tender, erythematous macules, often centered around hair follicles; as disease progresses, macules sometimes coalesce to form confluent plaques or papules; subepidermal bullae may occur Chronic graft versus host disease: evolves from acute form in 70-90% of patients; risk increases with the severity of acute reaction; violaceous lichenified papules, often on the ventral skin surfaces, very similar to those of lichen planus; lacy white plaques on the buccal mucosa; scattered scleroder-matous plaques; widespread disease resulting in ulcerations, joint contractures, and esophageal dysmotility

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