Graft-versus-host disease physical examination
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Graft-versus-host disease |
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Differentiating Graft-versus-host disease from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]
Overview
The physical exam for GvHD focuses on the organ involved, including the skin, liver, and GI tract. The lungs can also be involved in more rare cases.
Physical Examination
Skin
- erythema[1]
- maculopapular rash[1]
- hyperpigmentation[1]
- lichen planus-like lesions[1]
- bullae[2]
- desquamation[2]
Liver
- jaundice[1]
- pruritis[1]
- scleral icterus[1]
- leg swelling[1]
- tenderness in the right upper quadrant of the abdomen[1]
- bleeding from coagulopathy[1]
- signs of cholestatic hepatitis[1]
GI tract
- abdominal tenderness
- diarrhea
- hyperactive or hypoactive bowel sounds
Lungs
- decreased breath sounds
- crackles (if fluid fills the alveolar space)
Other organs
Other physical exam findings are based on the particular organ involved.
- Eye: If there is evidence of ocular GvHD, a full ophthalmologic exam should be done.[3] Ocular GvHD can occur in up to 60% of patients, but the clinical exam findings and severity of disease is variable from patient to patient. Findings in ocular GvHD include: ocular perforation, conjunctival damage, keratopathy (corneal damage), dry eyes, loss of eyelashes. Multiple layers of the eye can be affected, including the lid, lacrimal glands, and choroid.[2] Fluorescein staining of the eye can be performed.[3]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Socié G, Ritz J (2014). "Current issues in chronic graft-versus-host disease". Blood. 124 (3): 374–84. doi:10.1182/blood-2014-01-514752. PMC 4102710. PMID 24914139.
- ↑ 2.0 2.1 2.2 Nassar A, Tabbara KF, Aljurf M (2013). "Ocular manifestations of graft-versus-host disease". Saudi J Ophthalmol. 27 (3): 215–22. doi:10.1016/j.sjopt.2013.06.007. PMC 3770225. PMID 24227989.
- ↑ 3.0 3.1 Herretes S, Ross DB, Duffort S, Barreras H, Yaohong T, Saeed AM; et al. (2015). "Recruitment of Donor T Cells to the Eyes During Ocular GVHD in Recipients of MHC-Matched Allogeneic Hematopoietic Stem Cell Transplants". Invest Ophthalmol Vis Sci. 56 (4): 2348–57. doi:10.1167/iovs.14-15630. PMC 4406104. PMID 25655798.