Graft-versus-host disease differential diagnosis

Graft-versus-host disease
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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.

Differential Diagnosis

The differential diagnosis for GvHD can be categorized into the specific organs involved. When a post-transplant patient develops liver, GI, or skin 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 liver, GI tract, and skin can mimic symptoms of GvHD.

For liver signs and symptoms, differential diagnosis includes:

• CMV hepatitis
• Sinusoidal obstruction syndrome (hepatic veno-occlusive disease)
• Viral hepatitis
• Cholelithiasis
• Choledocholithiasis

For gastrointestinal signs and symptoms, differential diagnosis includes:

• Typhilitis (neutropenic enterocolitis)
• Clostridium difficile colitis
• Viral gastroenteritis
• Ischemic colitis

For skin signs and symptoms, differential diagnosis includes:

• Varicella zoster (shingles)
• Bacterial cellulitis
• Fungal skin infection (tinea corporis)
• Toxic erythema of chemotherapy