Background: The early diagnosis of acute cutaneous graft-versus-host disease (GVHD) is challenging as there are no specific features. Drug hypersensitivity reaction (DHR) is the most frequently encountered condition to differentiate from GVHD.
Objectives: We sought to investigate the clinical characteristics of acute cutaneous GVHD in comparison with DHR.
Methods: A retrospective chart review was conducted for allogeneic hemopoietic-cell transplantation recipients with maculopapular rashes who had undergone hemopoietic-cell transplantation less than 100 days earlier. We analyzed the clinical characteristics of 22 patients with acute cutaneous GVHD in comparison with 17 patients with DHR.
Results: Facial involvement was more frequent in the GVHD group (59%) than in the DHR group (24%). The difference was more significant when both the face and palms/soles were involved (36% in the GVHD group, no patients in the DHR group). Diarrhea was significantly more common in the GVHD group (73%) than in the DHR group (12%). The presence of both diarrhea and hyperbilirubinemia occurred only in the GVHD group (41%). In the GVHD group, the patients developed diarrhea and hyperbilirubinemia gradually with most patients exhibiting diarrhea and hyperbilirubinemia after 2 days.
Limitations: A retrospective design, small number of patients, and single-center design are limitations.
Conclusions: Facial involvement, and moreover involvement of the face and palms/soles, suggests the diagnosis of GVHD versus DHR. The presence of diarrhea, and diarrhea accompanied by hyperbilirubinemia is thought to favor the diagnosis of GVHD. Rashes with more than 2 to 3 days of duration and not accompanied by diarrhea and hyperbilirubinemia are less likely to be GVHD.
Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.