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  • Presentation

Distinguishing Graft-Vs-Host Disease from Other Morbilliform Eruptions in the Post-Transplant Period

Description

In this presentation, Brittany Dahlmage discusses the differentiation of morbilliform eruptions from graft-versus-host disease (GVHD) following hematopoietic stem cell transplants. The review begins with a case study of a 53-year-old woman post-transplant who develops a morbilliform rash 25 days after her procedure. Dahlmage outlines five key conditions to consider, including acute GVHD, engraftment syndrome, lymphocyte recovery eruption, viral exanthems, and drug eruptions. The timing of these eruptions is critical, as different syndromes manifest at specific intervals post-transplant, with engraftment syndrome typically occurring around day 14 and acute GVHD manifesting within 40-60% of patients due to HLA mismatching and other factors. The discussion emphasizes the importance of recognizing clinical presentations—such as facial and mucosal involvement—and understanding the distinct characteristics of GVHD in comparison to other eruptions. Skin biopsies can help in diagnosis, although subjective skin staging based on the extent of rash is also significant. Dahlmage highlights the potential for biomarkers in predicting GVHD severity, although their clinical application remains limited. The session concludes with recommendations on how to approach consults from bone marrow transplant teams, focusing on patient history and specific signs that can guide diagnosis.

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Conclusions

  • Acute graft-versus-host disease (GVHD) is a significant concern post-hematopoietic stem cell transplantation, affecting 40-60% of patients.
  • The timing of morbilliform eruptions is critical in distinguishing between various causes of skin eruptions in transplant patients.
  • Eruptions of lymphocyte recovery and engraftment syndrome are self-limited conditions that can mimic GVHD but have distinct features.
  • Hyperacute GVHD presents within 14 days of transplantation and has a poor prognosis with high mortality rates.
  • Involvement of target organs such as skin, liver, and gut is essential for diagnosing acute GVHD.
  • Facial, palm, and sole involvement significantly increases the likelihood of acute GVHD versus other eruptions.
  • Histological examination and staging criteria help diagnose GVHD but there is no gold standard for its diagnosis.
  • Research into biomarkers for diagnosing and predicting GVHD severity is ongoing but not yet clinically applicable.
  • The type of stem cell transplant influences the risk and incidence of GVHD, necessitating careful consideration of protocol during evaluation.
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