There are two manifestations of graft versus host disease (GVHD) including acute and chronic, which differ in the organs affected and when they present in patients.
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The symptoms of acute GVHD affect the skin, gut, and liver.
When the skin is affected in acute GVHD, an erythematous, maculopapular, and typically pruritic or itchy rash starts to appear on the palms of the hands, soles of the feet, shoulders, and ears. In severe cases, it can cause blisters and ulcers.
In mild forms of the disease, this rash might cover up to just 25% of the body. Comparatively, in more severe cases, the rash will cover most areas and the skin can start to peel off.
If a person has a moderate presentation of acute GVHD, they will start to feel nauseous. This can be accompanied by vomiting and an aversion to eating. The patient may experience early satiety and may also have signs of bloating.
The patient develops green, watery diarrhea, abdominal discomfort, and sometimes mucus and blood in their stool.
Liver function is affected as GVHD increases in severity. The patient may present with jaundice, which is a yellowing of the skin and eyes, as well as darkened urine. Jaundice may also be accompanied by right upper abdominal pain.
With the further worsening of the disease, the symptoms will become more severe as liver failure may ultimately ensue.
The patient may develop a fever or an increase in their body temperature.
The patient may have an increased susceptibility to infections from viruses, bacteria, and other microorganisms.
Changes in the blood
Patients tend to exhibit low levels of red blood cells and platelets.
The symptoms for chronic GVHD affect the skin, gut, and liver areas, as is the case in the acute manifestation of the disease. However, chronic GVHD can also extend to many other organs of the body. The condition can be mild, moderate, or severe.
Skin, hair, and nails
The patient will develop thickening of their skin texture. They will develop a rash which causes the skin to become dry and itchy. Alongside this, the patient’s nails will also break more easily and the hair may start to fall out or turn grey.
The patient can suffer from liver damage and/or failure.
In ocular GVHD, the eyes can become dry, painful, and uncomfortable. The patient’s vision can also become blurry and they may be unable to tolerate bright lights.
A persistent cough can develop with the patient struggling to breathe. Affected patients can also be at risk of chest infections.
Joints and tendons
Joints can become painful and stiff while the movement of the legs will become more difficult due to inflamed tendons.
Sores can form inside the mouth. The patient may feel pain as well and find it difficult to open their mouth.
The genital region can become inflamed and cause sexual activity to be uncomfortable
Doctors tend to use various biopsies in the diagnosis of both acute and chronic GVHD, which involves the removal and analysis of tissue from an affected area. A pathologist will analyze the tissue and decide whether the symptoms and findings correspond with suspected GVHD. The process of diagnosing is often one where the doctor rules out different diseases based on the results.
A skin biopsy begins with the doctor numbing the skin to snip a little bit of flesh from the affected area. Elafin, also known as the protein peptidase inhibitor 3, tends to be abundant in skin affected by GVHD. It modulates inflammation.
A liver biopsy requires the patient to undergo an ultrasound or computed tomography (CT) scan to help the doctor see the affected area more clearly for the liver biopsy. A needle is then used to take a little sample of the flesh for analysis. Doctors will look for an increase in alkaline phosphatase and bilirubin, which indicate that the liver is not functioning properly.
Endoscopy, gastroscopy, and colonoscopy
The stomach and intestinal areas may need to be assessed as well. The doctor will use a camera to look into the esophagus or insert one through the anus to look at the bowel or colon area. A little snip of the flesh is obtained for analysis.
The doctor can also use X-rays or CT to look at the health of the lungs. This diagnostic tool can also be supplemented with further lung function tests.