PMC8651419_01
Axial abdominal CT angiogram showing free air in peritoneal cavity (white arrow) secondary to perforated duodenum.
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fig1
An abdominal CT scan showed pneumoperitoneum and suspicion for duodenal perforation (Figure 1); he was emergently taken to the operating room for repair of a perforated ulcer in the first part of duodenum.
Petechial rash on trunk, axilla, neck, and arm.
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fig2
A new petechial rash was noted on his legs and arms on hospital day 7 (Figure 2).
(a) Punch biopsy showing paucicellular lymphocytic infiltrate within the dermis (hematoxylin-eosin, original magnification x100). (b) Dyskeratotic cells in the epidermis (hematoxylin-eosin, original magnification x200).
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fig3
The skin biopsy was significant for interface dermatitis with dyskeratotic keratinocytes consistent with the diagnosis of aGvHD (Figure 3).
PMC8651419_02
Maculopapular rash on trunk and legs.
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fig4
The following day, he developed a diffuse maculopapular rash (Figure 4).
(a) Dyskeratotic cells in the epidermis (hematoxylin-eosin, original magnification x200). (b) Lymphocytes in close apposition to apoptotic keratinocytes (satellite cell necrosis), (hematoxylin-eosin, original magnification x400).
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fig5
On hospital day 7, the chimerism studies resulted with 92% donor cells, and skin biopsy was significant for vacuolar interface dermatitis with dyskeratotic keratinocytes (Figure 5) consistent with aGVHD.
C-reactive protein trend during hospitalization for case 2.
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On ruxolitinib, the rash and ANC improved with a decline in C-reactive protein (CRP) level (Figure 6).