Three weeks after a small bowel transplant, a recipient develops a maculopapular rash on the palms, watery diarrhoea, and pancytopenia. Skin biopsy shows keratinocyte necrosis with apoptotic bodies and a lymphocytic infiltrate. What is the diagnosis?

• A Acute cellular rejection of the graft
• B Graft versus host disease ✓
• C Post-transplant lymphoproliferative disorder
• D Drug eruption from tacrolimus

Explanation

Graft versus host disease occurs when immunocompetent donor lymphocytes in the graft attack host tissues, targeting skin, gut, and bone marrow. Small bowel and liver transplants carry the highest risk because they contain large amounts of donor lymphoid tissue, unlike heart or kidney. Acute rejection attacks the graft itself rather than the host, and PTLD is an EBV driven B-cell proliferation presenting as a mass or lymphadenopathy, not a rash with marrow failure.

Reference: Schwartz Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.