Clinical differentiation of acute cutaneous graft-versus-host disease from drug hypersensitivity reactions - 14/09/11
Reprint requests: Kwang Hyun Cho, MD, Department of Dermatology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, Korea, 110-744.Abstract |
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.
Le texte complet de cet article est disponible en PDF.Key words : diarrhea, differential diagnosis, drug hypersensitivity reaction, early diagnosis, graft-versus-host disease, hemopoietic-cell transplantation, hyperbilirubinemia
Abbreviations used : DHR, GVHD, HCT
Plan
| Funding sources: None. |
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| Conflicts of interest: None declared. |
Vol 65 - N° 4
P. 726-732 - octobre 2011 Retour au numéro
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