Graft-vs-host disease (GVHD) is divided into acute and chronic phasesbased on time and clinical and histological features. The criterion of 100days after transplantation for separating acute GVHD from chronic GVHD hasbeen challenged on the following points: (1) the lichenoid rash of chronicGVHD may be observed as early as day 31 and acute GVHD may persist after day100 in some cases, and (2) specific histological features do not consistentlyseparate acute from chronic GVHD defined as the number of days after transplantation.However, the appearance of acute cutaneous GVHD after day 100 is not wellestablished.
Three patients developed a rash with clinical and histological featuresof acute GVHD between days 153 and 192 after allogeneic bone marrow transplantationor peripheral blood stem cell transplantation. In all patients, the late flareof acute GVHD occurred after tapering or suspending the immunosuppressiveregimen with cyclosporine or corticosteroids, and was accompanied by stigmataof chronic GVHD in other target organs.
The rash of acute GVHD may be observed as late as 192 days after transplantation,especially after tapering or suspending the immunosuppressive drugs, and shouldbe considered in the differential diagnosis of late erythematous eruptionsafter transplantation.