Graft-versus-host disease history and symptoms
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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 clinical presentation of GvHD can be quite diverse, depending on the types of organs affected and the severity of the immunologic reaction.
History and Symptoms
Classically, acute graft-versus-host-disease is characterized by selective damage to the liver, skin and mucosa, and the gastrointestinal tract. Other graft-versus-host-disease target organs include the immune system (the hematopoietic system, such as the bone marrow and the thymus) itself, and the lungs in the form of idiopathic pneumonitis. Chronic graft-versus-host-disease also attacks the above organs, but over its long-term course can also causes damage to the connective tissue and exocrine glands.
- GI symptoms: Severe diarrhea, abdominal pain, nausea, and vomiting. Diarrhea is typically large-volume and bloody stools can also develop.[1] The volume of diarrhea determines the stage of GI GvHD. This is typically diagnosed via intestinal biopsy, which can be done via endoscopy or colonoscopy.
- Liver symptoms: Jaundice (yellowing of the skin). Acute liver GvHD is measured by the bilirubin level in acute patients.[1] The degree of bilirubin elevation determines the stage of liver GvHD.
- Skin symptoms: Diffuse maculopapular rash, sometimes in a lacy pattern. This can be diagnosed via skin biopsy.
- Pulmonary symptoms: Shortness of breath and cough. Severe pneumonitis can result in respiratory failure requiring intubation.
References
- ↑ 1.0 1.1 McDonald GB (2016). "How I treat acute graft-versus-host disease of the gastrointestinal tract and the liver". Blood. 127 (12): 1544–50. doi:10.1182/blood-2015-10-612747. PMC 4807421. PMID 26729898.