Graft-versus-host disease history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

The clinical presentation of GvHD can be quite diverse, depending on the types of organs affected and the severity of the immunologic reaction. Generally, gastrointestinal symptoms include diarrhea, abdominal pain, nausea and vomiting. Liver involvement presents as jaundice (yellow skin). Skin symptoms include a diffuse maculopapular rash. Pulmonary symptoms present as shortness of breath and cough.

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.

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