Question

A 38-year-old woman was treated for chronic myelogenous leukemia, with an allogeneic bone marrow transplant. She was released from the hospital with prescriptions for cyclosporine and steroids. She was readmitted 5 weeks after the transplant, noting abdominal cramping, nausea, and watery diarrhea. Over the last 2 weeks, she had developed a skin rash on her hands and feet, and the rash had spread to other parts of her body, peeling and blistering, giving her skin the appearance of severe sunburn. Physical examination revealed mild jaundice. Bloodwork showed elevated levels of bilirubin, SGOT, and alkaline phosphatase.

Question
What is the most likely diagnosis?

Hepatitis B
Chronic Graft vs Host disease (GVHD)
Acute Graft vs Host disease (GVHD)
HIV
Relapse of chronic myelogenous leukemia (CML)

Answer 1

The symptoms described suggest that the 38-year-old woman is experiencing Acute Graft vs Host disease (GVHD), which commonly follows a bone marrow transplant and presents with skin rashes, liver damage, and gastrointestinal issues.

Step-by-step explanation:

The most likely diagnosis for the 38-year-old woman who has been treated with an allogeneic bone marrow transplant for chronic myelogenous leukemia and is now presenting with abdominal cramping, nausea, watery diarrhea, a rash on her hands and feet that has spread and blistered, along with mild jaundice and elevated levels of bilirubin, SGOT, and alkaline phosphatase is Acute Graft vs Host disease (GVHD).

Acute GVHD typically occurs within weeks after a bone marrow transplant, which aligns with the 5-week timeline post-transplant that the patient was readmitted.

Symptoms of acute GVHD include skin rashes, liver damage, as indicated by jaundice and abnormal liver function tests, and gastrointestinal symptoms like those experienced by the patient.

Graft-versus-Host Disease occurs when donor bone marrow cells containing lymphocytes mount an immune response against the recipient's tissues. The donor's T cells attack the recipient cells, leading to the symptoms observed.

Given the recent bone marrow transplant and the cluster of symptoms described, acute GVHD is considered the primary diagnosis over other potential diagnoses such as Hepatitis B, chronic GVHD, HIV infection, or relapse of chronic myelogenous leukemia (CML).