case_images: PMC8651419_01
case_images: Axial abdominal CT angiogram showing free air in peritoneal cavity (white arrow) secondary to perforated duodenum.
case_images: CRIT2021-8981429.001.jpg
case_images: PMC8651419_01_CRIT2021-8981429.001.jpg
case_images: fig1
case_images: 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.
case_images: Petechial rash on trunk, axilla, neck, and arm.
case_images: CRIT2021-8981429.002.jpg
case_images: PMC8651419_01_CRIT2021-8981429.002.jpg
case_images: fig2
case_images: A new petechial rash was noted on his legs and arms on hospital day 7 (Figure 2).
case_images: (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).
case_images: CRIT2021-8981429.003.jpg
case_images: PMC8651419_01_CRIT2021-8981429.003.jpg
case_images: fig3
case_images: The skin biopsy was significant for interface dermatitis with dyskeratotic keratinocytes consistent with the diagnosis of aGvHD (Figure 3).
case_images: PMC8651419_02
case_images: Maculopapular rash on trunk and legs.
case_images: CRIT2021-8981429.004.jpg
case_images: PMC8651419_02_CRIT2021-8981429.004.jpg
case_images: fig4
case_images: The following day, he developed a diffuse maculopapular rash (Figure 4).
case_images: (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).
case_images: CRIT2021-8981429.005.jpg
case_images: PMC8651419_02_CRIT2021-8981429.005.jpg
case_images: fig5
case_images: 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.
case_images: C-reactive protein trend during hospitalization for case 2.
case_images: CRIT2021-8981429.006.jpg
case_images: PMC8651419_02_CRIT2021-8981429.006.jpg
case_images: fig6
case_images: On ruxolitinib, the rash and ANC improved with a decline in C-reactive protein (CRP) level (Figure 6).