Defibrotide-Responsive Cutaneous Endothelial Injury Following Allogeneic Hematopoietic Stem Cell Transplant: A Case Report.

A 57 -year -old woman with relapsed Philadelphia chromosome -negative B -cell acute lymphoblastic leukemia developed diffuse non -blanching erythematous skin lesions following allogeneic hematopoietic stem cell transplant. The lesions appeared concomitantly with hepatic sinusoidal obstruction syndrome and persisted despite engraftment and supportive therapy. Skin biopsy excluded graft -versus -host disease. Upon initiation of defibrotide for moderate hepatic sinusoidal obstruction syndrome, both hepatic and cutaneous findings resolved completely. This case underscores the systemic endothelial -protective potential of defibrotide, extending beyond the hepatic microvasculature, and highlights cutaneous endotheliopathy as a possible manifestation of transplant -associated endothelial injury.