Symptoms and Diagnosis of Graft Versus Host Disease (GVHD)

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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Acute GVHD

The symptoms of acute GVHD affect the skin, gut, and liver.

Skin

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.

Stomach

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.

Intestines

The patient develops green, watery diarrhea, abdominal discomfort, and sometimes mucus and blood in their stool.

Liver

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.

Temperature

The patient may develop a fever or an increase in their body temperature.

Infections

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.

Chronic GVHD

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.

Liver

The patient can suffer from liver damage and/or failure.

Eyes

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.

Lungs

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.

Mouth

Sores can form inside the mouth. The patient may feel pain as well and find it difficult to open their mouth.

Genital region

The genital region can become inflamed and cause sexual activity to be uncomfortable

Diagnosis

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.

Skin biopsy

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.

Liver biopsy

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.

Diagnostic imaging

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.

References

Further Reading

Last Updated: Apr 8, 2021

Deborah Fields

Written by

Deborah Fields

Deborah holds a B.Sc. degree in Chemistry from the University of Birmingham and a Postgraduate Diploma in Journalism qualification from Cardiff University. She enjoys writing about the latest innovations. Previously she has worked as an editor of scientific patent information, an education journalist and in communications for innovative healthcare, pharmaceutical and technology organisations. She also loves books and has run a book group for several years. Her enjoyment of fiction extends to writing her own stories for pleasure.

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