Graft-versus-host disease differential diagnosis
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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 differential diagnosis of GvHD is broad given the complexity of post-transplant patients. Infectious etiologies must be considered in persons who under stem cell transplant. A skin rash in the post-transplant setting, for example, could reflect infectious dermatitis or skin GvHD. Liver dysfunction in the post-transplant setting, for example, can reflect an infectious hepatitis of liver GvHD. Gastrointestinal symptoms in the post-transplant setting, for example, could reflect infectious enteritis/colitis or GI GvHD.
Differential Diagnosis
The differential diagnosis for GvHD can be categorized into the specific organs involved. When a post-transplant patient develops skin, liver, or [Gastrointestinal tract|GI,]] symptoms, there are numerous possibilities regarding the etiology, as post-transplant patients are immunocompromised and at risk for infections. The clinical manifestations of infection in the skin, liver, or GI tract can mimic symptoms of GvHD.
For skin signs and symptoms, differential diagnosis includes:
- Varicella zoster (shingles)
- Bacterial cellulitis
- Fungal skin infection (tinea corporis)
- Toxic erythema of chemotherapy
- Drug eruption
For liver signs and symptoms, differential diagnosis includes:
- CMV hepatitis[1]
- Sinusoidal obstruction syndrome (hepatic veno-occlusive disease)
- Viral hepatitis[1]
- Cholelithiasis
- Choledocholithiasis
For gastrointestinal signs and symptoms, differential diagnosis includes:
- Typhilitis (neutropenic enterocolitis)
- Clostridium difficile colitis
- Viral gastroenteritis[1]
- Ischemic colitis
References
- ↑ 1.0 1.1 1.2 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.