Follicular graft-vs-host disease (GVHD) was probably first reported in 1984.¹ Clinically acute follicular GVHD was described as an eruption similar to a bacterial or fungal folliculitis following allogenic bone marrow transplantation (BMT).² Cases of clinically acute and chronic follicular GVHD have been described.^3-6 We report the unexpected finding of follicular lichenoid GVHD in a biopsy specimen from a nonspecific lesion that appeared on a patient on the 18th day after BMT.

A 39-year-old woman with acute lymphocytic leukemia, L₂type, Philadelphia chromosome positive, and common acute lymphoblastic leukemia antigen positive, in complete remission was treated with an HLA-matched allogenic BMT from her brother following conditioning with intravenous cyclophosphamide (60 mg/kg per day) on days 6 and 5 before BMT and total body irradiation from days 4 to 1 before BMT. Prophylactic treatment against GVHD included intravenous cyclosporin A (1.5 mg/kg every 12 hours) from day 0 and methotrexate, 15 mg/m² on day 1 and 10 mg/m² on days 3, 6, and 11. On the 18th day after BMT (leukocyte count, 0.89 × 10³/μL (30% neutrophile), 3 erythematous itching plaques with prominent follicles on the surface developed on the submammary folder (Figure 1). A biopsy specimen of 1 of these lesions revealed a slight edema of the dermis and a sparse, superficial, perivascular, lymphocytic infiltrate. The most significant findings were a focal basilar dyskeratosis and a lichenoid infiltrate surrounding the lower portion of the follicular epithelium, with a lack of these changes in the epidermis (Figure 2). Topical corticosteroid therapy was begun on day 18, and the lesions disappeared in 48 hours.