Table 2.
Mimics of gastrointestinal and hepatic GVHD
| Upper-gut GVHD | Lower-gut GVHD | Hepatic GVHD | ||
|---|---|---|---|---|
| Early jaundice | Cholestatic | Hepatitic | ||
| Nauseating medications | Residual effects of conditioning therapy (<day 20) | Cholangitis lenta (infection-related jaundice from IL-6, TNF-α) | Cholangitis lenta (infection-related jaundice from IL-6, TNF-α) | Hepatitis virus infection (HBV, HCV) |
| Residual effects of conditioning therapy (<day 20) | Viral infection (CMV > adenovirus > astrovirus, norovirus, rotavirus) | Drug-induced liver injury (DILI; http://www.dilin.org/) | Biliary obstruction (sludge, stones, tumor) | Other viral infections (adenovirus > herpesviruses) |
| Herpesvirus infections | Bacterial infection (Clostridium difficile > Clostridium septicum) | Residual effects of SOS | DILI | DILI |
| Helicobacter pylori infection with ulcers | Parasitic infection (Giardia lamblia, cryptosporidia) | Hypoxic hepatitis (SOS, respiratory failure, shock) | ||
| Increased intracranial pressure | Medication effects (Mg++, MMF, brincidofovir, anticholinergics, μ-agonist opioids) | |||
| Phlegmonous gastritis | ||||
These disorders may also coexist with GVHD.
CMV, cytomegalovirus; HBV, hepatitis B virus; HCV, hepatitis C virus; IL-6, interleukin 6; MMF, mycophenolate mofetil; SOS, sinusoidal obstruction syndrome; TNF-α, tumor necrosis factor α.