<prompt> Answer this question truthfullyWhat are the possible diagnoses that need to be considered for Graft-versus-host disease?  <response>: <reason> The differential diagnosis for GvHD can be categorized into the specific organs involved. When a post-transplant patient develops skin, liver, or Gastrointestinal tractGI, symptoms, there are numerous possibilities regarding the etiology, as post-transplant patients are immunocompromised and at risk for infections. The clinical manifestations of infection in the skin, liver, or GI trac t can mimic symptoms of GvHD.For skin signs and symptoms, differential diagnosis includes:Varicella zoster shingles Bacterial cellulitis Fungal skin infection tinea corporis Toxic erythema of chemotherapy Drug eruptionFor liver signs and symptoms, differential diagnosis includes:CMV hepatitis Sinusoidal obstruction syndrome hepatic veno-occlusive disease Viral hepatitis Cholelithiasis CholedocholithiasisFor gastrointestinal signs and symptoms, differential diagnosis includes:Typhilitis neutropenic enterocolitis Clostridium difficile colitis Viral gastroenteritis Ischemic colitisChronic graft-versus-host disease must be differentiated from other diseases that cause skin thickening such as scleredema, scleromyxedema, eosinophilic fasciitis, scleroderma, drug induced scleroderma, scleroderma overlap syndromes, diabetic cheiroarthropathy, myxedema, and nephrogenic systemic fibrosis.Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings Symptoms Physical examination Lab Findings Imaging Histopathology Skin thickening Raynaud phenomenon Heart burn Edema swelling Sclerodactyly Telangiectasia Impaired mobility Autoantibodies Blood indices Scleroderma Chronic graft-versus-host disease induration - - - - - Antinuclear antibody ANA Anti-mitochondrial antibody Increased serum bilirubin concentration NA Thick collagen bundles in the dermis Normal appearing epidermis Skin biopsy Occurs after allogeneic hematopoietic transplantation Pulmonary fibrosis Esophageal sclerosis Limited cutaneous systemic sclerosis CREST syndrome induration - - Anti-centromere antibody Antinuclear antibody ANA Anemia Elevated creatinine level Nailfold microvascular changes on nailfold video capillaroscopy NVC Chest HRCT scan showing evidence of pulmonary fibrosis Nailfold microvascular changes Dilated capillary loops Microhemmorhages American College of Rheumatology ACR European League Against Rheumatism EULAR classification criteria Interstitial lung disease Pulmonary hypertension Calcinosis Dyspnea Scleredema Buschkes disease - - - - NA Fasting blood sugar HbA1C NA Normal epidermis Thickened dermis with swelling of collagen Fibroblast proliferation is absent in the dermis Skin biopsy Symmetrical skin thickening Trunk, shoulders, upper back, face Fingers are spared Immobility of shoulders and chest Associated with viral URTI and diabetes mellitus type 1, monoclonal gammopathy Scleromyxedema lichen myxedematosus waxy yellow-red papules - - - - - NA Monoclonal gammopathy IgG-lambda Normal TSH NA Fibroblast proliferation in the dermis Mucin deposition in the dermis Skin biopsy Associated with malignancies AL amyloidosis Normal thyroid function Scalp and head are affected Eosinophilic fasciitis orange peel- peau dorange appearance - - - - - NA Eosinophilia peripheral blood smear Normal appearance on nailfold video capillaroscopy NVC Fascia is edematous and infiltrated by eosinophils Skin biopsy Fasciitis present on the trunk sparing extremities Visible collapse of superficial veins when the limb is elevated Hands and feet are not involved Drug-induced scleroderma - - - - NA NA NA IgG and complement deposits on epidermal keratinocytes Skin biopsy Bleomycin Cancer chemotherapeutic drugs Skin changes present on trunk and extremities Diffuse cutaneous systemic sclerosis induration - - Anti-topoisomerase-I Scl-70 antibody Anti-RNA polymerase III antibody Antinuclear antibody ANA Anemia Elevated creatinine level Nailfold microvascular changes on nailfold video capillaroscopy NVC Chest HRCT scan showing evidence of pulmonary fibrosis Nailfold microvascular changes Dilated capillary loops Microhemmorhages American College of Rheumatology ACR European League Against Rheumatism EULAR classification criteria Interstitial lung disease Pulmonary hypertension Scleroderma renal crisis Dyspnea Scleroderma overlap syndromes Scleroderma- systemic lupus erythematosus overlap rash - - Anti-Ro52 antibody Antinuclear antibody ANA Anti-Smith antibody Anti-dsDNA antibody Antiphospholipid antibody Anti-centromere antibody ACA Anti-topoisomerase-I Scl-70 antibody Anti-RNA polymerase III antibody Decreased C3, C4 and CH50 Anemia NA Inflammation at the dermal - epidermal junction Anti-Ro52 antibody Anti-dsDNA antibody Malar butterfly rash Arthritis Scleroderma- polymyositis overlap rash - - Anti-Ro52 antibody Antinuclear antibody ANA Anti-Jo-1 antibody Anti-SRP antibody Anti-Mi-2 antibody Anti-centromere antibody ACA Anti-topoisomerase-I Scl-70 antibody Anti-RNA polymerase III antibody Elevated creatine kinase Aldolase Anemia NA Inflammation at the dermal - epidermal junction Atrophy of the epidermis Perivascular infiltrate in the dermis Necrosis and atrophy of endomysial connective tissue on muscle biopsy Anti-Ro52 antibody Muscle biopsy Symmetric proximal muscle weakness Scleroderma- rheumatoid arthritis overlap rash - - Anti-Ro52 antibody Antinuclear antibody ANA Rheumatoid factor RF ve Anti-CCP antibody Anti-centromere antibody ACA Anti-topoisomerase-I Scl-70 antibody Anti-RNA polymerase III antibody Elevated ESR Anemia NA Inflammation at the dermal - epidermal junction Anti-Ro52 antibody Anti-CCP antibody Clinical findings that suggest rheumatoid arthritis RA but do not fulfill the ACR criteria for RA Endocrine disorders Diabetic cheiroarthropathy waxy skin - - - - NA Fasting blood sugar 126 mgdL HbA1C 6.5 NA NA Fasting blood sugar 126 mgdL HbA1C 6.5 Long standing type I diabetes mellitus Skin thickening of fingers Flexion contractures on fingers Myxedema coarse skin - - - - - Anti-TPO antibody Anti-Tg antibody Anemia Serum TSH elevated NA Atrophied epidermis Hyperkeratosis Serum TSH Hypothyroidism Nonpitting edema present Renal diseases Nephrogenic systemic fibrosis induration - - - - NA Elevated C-reactive protein Elevated ESR Decreased serum albumin Decreased creatinine clearance NA Fibrosis of dermis Accumulation of CD34 positive fibroblasts Skin biopsy Skin changes on extremities and trunk involves hand and feet Affects patients with advanced dialysis dependent renal failure Gadolinium containing contrast exposure is a risk factor Internal organ fibrosis can occur 