Severe Oral Chronic Graft-versus-Host Disease With Functional Impairment After Allogeneic Hematopoietic Stem Cell Transplantation: A Case Report: reporte de caso

Abstract

Oral chronic graft-versus-host disease is a clinically significant complication of allogeneic hematopoietic stem cell transplantation. It may affect the oral mucosa, salivary glands, and oral function, causing pain, xerostomia, impaired eating, speech difficulties, and reduced ability to maintain oral hygiene. Lichenoid lesions are among the most relevant diagnostic findings, whereas ulceration, erythema, and xerostomia require careful differential assessment. We report the case of a 55-year-old Salvadoran woman with a history of acute myeloid leukemia who underwent allogeneic hematopoietic stem cell transplantation from a related donor. Around day +335 after transplantation, she developed severe oral pain, burning sensation, xerostomia, and mucosal lesions that interfered with food intake, speech, and daily oral hygiene. Intraoral examination revealed lichenoid, hyperkeratotic, erythematous, and ulcerative lesions involving the tongue and buccal mucosa. Because oral chronic graft-versus-host disease was suspected, an oral biopsy and complementary hematological studies were performed to support the diagnosis and exclude hematological relapse or graft failure. Initial management included meticulous oral hygiene measures, topical corticosteroid therapy, antifungal treatment, and symptomatic care. After clinical worsening at the first follow-up, treatment was intensified with dexamethasone oral rinse and systemic corticosteroids. Subsequent evaluations showed progressive reduction of oral lesions and improvement of symptoms, although xerostomia persisted. This case highlights the importance of early recognition, stepwise treatment, and multidisciplinary follow-up in oral chronic graft-versus-host disease. Oral and maxillofacial specialists play a central role in identifying diagnostic lesions, preserving oral function, and supporting long-term surveillance.