HSCT Complications and Graft-versus-Host Disease - Case Study - Rash, Diarrhea, Jaundice at Day 32

A forty-one-year-old aircraft mechanic presents to his transplant attending at day plus thirty-two with a spreading rash, watery diarrhea, and a rising bilirubin - and the resident has to defend, organ by organ, why this is acute graft-versus-host disease and not a drug rash, a viral exanthem, veno-occlusive disease, or tacrolimus toxicity. A resident presents this case to an attending on teaching rounds, reasoning through the three-phase mechanism, the competing differential, the grading and treatment decision, and where this patient sits on the post-transplant infection timeline. What you'll learn: • How to build the differential for a rash, diarrhea, and rising bilirubin after transplant • The three-phase mechanism behind acute GVHD, walked through at the bedside • Why day plus thirty-two points toward GVHD and toward viral reactivation at once • How organ grading drives the choice between topical and systemic therapy • Why tacrolimus toxicity has to be ruled out before calling this disease progression Key takeaway: Day plus thirty-two is exactly where acute GVHD and viral reactivation overlap - reasoning through the timeline is the diagnosis. ⏱ Chapters: 0:00 The presentation: a new triad at day 32 2:40 The mechanism: three phases of acute GVHD 7:07 Assessment, plan, and management 10:58 Trajectory ahead and teaching pearls Part of Teaching Service - Hospital Rounds: education for residents and advanced practice providers. For clinician and trainee education only. Not medical advice; verify against current guidelines and institutional protocols before applying to patient care. #GraftVersusHostDisease #GVHD #HSCT #CaseStudy #TeachingRounds #BoneMarrowTransplant #TransplantMedicine #Hematology #Oncology #MedicalEducation