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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Oncology · Graft-Versus-Host Disease

Signs to Watch For: Symptoms and Warning Signs

At a Glance

Early detection of Graft-Versus-Host Disease (GVHD) symptoms is critical for effective management. Watch for sunburn-like rashes, watery diarrhea, jaundice, and severe dryness in the eyes or mouth, and treat any fever of 100.4°F or higher as a medical emergency.

Early detection is the most powerful tool you have in managing Graft-Versus-Host Disease (GVHD). Because the symptoms can sometimes mimic other common post-transplant issues, it is essential to report any new or changing physical signs to your care team immediately, even if they seem minor.

CRITICAL INFECTION SAFETY PROTOCOL
Because you are on medications that suppress your immune system to control or prevent GVHD, you are at a very high risk for infections. A fever is a medical emergency.

  • Call your doctor or go to the ER immediately if your temperature reaches 100.4°F (38.0°C) or higher.
  • Do not take fever-reducing medications (like Tylenol) before calling your doctor, as this can hide the fever.

Recognizing Acute GVHD (The First 100 Days and Beyond)

Acute GVHD typically focuses on three main “target organs.” Your team will often use the MAGIC criteria (Mount Sinai Acute GVHD International Consortium) to measure the severity of these symptoms [1][2].

  • The Skin: Usually the first sign. Look for a faint red rash that looks like a sunburn. It often starts on the neck, ears, shoulders, palms of the hands, or soles of the feet [3][4].
  • The GI Tract (Gut): Symptoms can include persistent nausea, vomiting, or a loss of appetite. The most common sign, however, is watery diarrhea or abdominal cramping [3][5].
    • At-Home Tip: If you develop diarrhea, stick to a bland diet (like bananas, rice, applesauce, and toast) and stay hydrated with electrolyte drinks. DO NOT take over-the-counter anti-diarrheal medications (like Imodium or Pepto-Bismol) without calling your doctor first, as this can mask severe symptoms or worsen an infectious cause [6].
  • The Liver: You may not “feel” liver GVHD. It is usually caught through blood tests showing elevated bilirubin (a yellow pigment) or liver enzymes [3][4]. In more visible cases, the skin or whites of the eyes may begin to look yellow (jaundice).

Recognizing Chronic GVHD

Chronic GVHD is more varied and can affect almost any part of the body. It often feels more like a slow-moving autoimmune condition [7].

  • Eyes & Mouth: You might notice persistent dryness, a “gritty” feeling in the eyes, or sensitivity to light [8]. In the mouth, you may have white patches, sensitivity to spicy foods, or a very dry mouth (xerostomia) [9].
  • Skin & Joints: Chronic skin GVHD can cause changes in texture. Skin may feel thick, tight, or “woody” (sclerosis) [7]. This tightness can sometimes make it harder to fully extend your joints, like your elbows or fingers.
  • Lungs: This can show up as a dry cough or feeling short of breath, especially when you are active [7][10].
  • Other Areas: Chronic GVHD can also affect the nails (becoming brittle or ridged), the hair (thinning or loss), and the genitourinary tract [11][12].

“Is it GVHD?” — Common Look-Alikes

Not every symptom after a transplant is GVHD. Your doctors must carefully rule out other conditions that look very similar [13]:

Symptom Could be GVHD, but could also be…
Skin Rash A reaction to an antibiotic or antifungal medication (drug rash), or a viral infection [13].
Diarrhea A common infection like C. diff or a side effect of chemotherapy [6].
Liver Issues Side effects from medications or a blockage in the liver’s blood vessels (VOD/SOS).

To tell the difference, your doctor might recommend a biopsy—taking a tiny sample of tissue from the skin or the lining of the gut to look at under a microscope [6][14]. They may also use the Lee Symptom Scale, a questionnaire that helps you and your team track how these symptoms are affecting your daily life [15][16].

Common questions in this guide

What does a GVHD skin rash look like?
An acute GVHD rash typically starts as a faint red patch that looks like a sunburn. It most commonly appears first on the neck, ears, shoulders, palms of the hands, or soles of the feet.
What should I do if I get a fever while being treated for GVHD?
A fever of 100.4°F (38.0°C) or higher is a medical emergency because your immune system is suppressed. Call your doctor or go to the emergency room immediately, and do not take fever-reducing medications like Tylenol before calling, as they can hide the fever.
How do I know if my diarrhea is from GVHD or an infection?
Diarrhea can be a sign of acute GVHD in the gut, but it can also be caused by an infection or chemotherapy side effects. Your doctor may need to run tests or perform a biopsy of your gut lining to confirm the exact cause.
Can GVHD affect my eyes and mouth?
Yes, chronic GVHD frequently causes severe dryness or a gritty feeling in the eyes. In the mouth, it can cause persistent dryness, white patches, and sensitivity to spicy foods.
Why does my skin feel tight and my joints feel stiff after transplant?
Chronic GVHD can cause changes in skin texture, making it feel thick, tight, or hard. This tightness, known as sclerosis, can sometimes make it difficult to fully extend joints like your elbows or fingers.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does this rash look like GVHD, or could it be a reaction to one of my medications?
  2. 2.If I start having diarrhea, at what point should I call the clinic or head to the emergency room?
  3. 3.I'm noticing some eye dryness; should I see an ophthalmologist who specializes in transplant patients?
  4. 4.Are my current breathing tests or liver enzyme levels showing any early signs of GVHD?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (16)
  1. 1

    Biomarkers in acute graft-versus-host disease: new insights.

    Srinagesh HK, Levine JE, Ferrara JLM

    Therapeutic advances in hematology 2019; (10()):2040620719891358 doi:10.1177/2040620719891358.

    PMID: 31839920
  2. 2

    Prediction and Prognostication of Acute Graft-Versus-Host Disease by MAGIC Biomarkers.

    Levine JE

    American journal of hematology 2025; (100 Suppl 3()):5-13 doi:10.1002/ajh.27594.

    PMID: 40123552
  3. 3

    Toward Improving Initial Therapy of Acute Graft Versus Host Disease.

    Mehta AK, Koreth J

    American journal of hematology 2025; (100 Suppl 3()):40-54 doi:10.1002/ajh.27593.

    PMID: 39936555
  4. 4

    Nonclassical manifestations of acute GVHD.

    Zeiser R, Teshima T

    Blood 2021; (138(22)):2165-2172 doi:10.1182/blood.2021012431.

    PMID: 34482399
  5. 5

    MAGIC biomarkers of acute graft-versus-host disease: Biology and clinical application.

    Srinagesh HK, Ferrara JLM

    Best practice & research. Clinical haematology 2019; (32(4)):101111 doi:10.1016/j.beha.2019.101111.

    PMID: 31779977
  6. 6

    Patterns and Grading of Gastrointestinal Graft-Versus-Host Disease: A Clinicopathologic Correlation Study.

    Kuş Öztürk S, Kırmızı A, Aras N, et al.

    The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 2023; (34(5)):516-524 doi:10.5152/tjg.2023.22012.

    PMID: 36806183
  7. 7

    Chronic graft-versus-host disease. Part II: Disease activity grading and therapeutic management.

    Baumrin E, Loren AW, Falk SJ, et al.

    Journal of the American Academy of Dermatology 2024; (90(1)):19-36 doi:10.1016/j.jaad.2022.12.023.

    PMID: 36572064
  8. 8

    Dessicating stress triggers and exacerbates experimental ocular Graft-versus-host-disease.

    Gehlsen U, Maass M, Stary D, et al.

    The ocular surface 2025; (37()):236-246 doi:10.1016/j.jtos.2025.04.008.

    PMID: 40287060
  9. 9

    Topical treatment of oral chronic graft-versus-host- disease in hematopoietic stem cell transplant recipients: A systematic review.

    Haas L, Cruz-Pamplona M

    Journal of clinical and experimental dentistry 2023; (15(5)):e420-e427 doi:10.4317/jced.60138.

    PMID: 37214749
  10. 10

    Chronic graft-versus-host disease. Part I: Epidemiology, pathogenesis, and clinical manifestations.

    Baumrin E, Loren AW, Falk SJ, et al.

    Journal of the American Academy of Dermatology 2024; (90(1)):1-16 doi:10.1016/j.jaad.2022.12.024.

    PMID: 36572065
  11. 11

    A prospective study of female genital chronic graft-versus-host disease symptoms, signs, diagnosis and treatment.

    Smith Knutsson E, Björk Y, Broman AK, et al.

    Acta obstetricia et gynecologica Scandinavica 2018; (97(9)):1122-1129 doi:10.1111/aogs.13366.

    PMID: 29752810
  12. 12

    Exploratory study on the efficacy of topical pan-JAK inhibitor in ocular and skin GVHD in a sclerodermatous GVHD mouse model.

    Sato S, Ogawa Y, Asai K, et al.

    Scientific reports 2025; (15(1)):532 doi:10.1038/s41598-024-84380-6.

    PMID: 39748084
  13. 13

    Acute Graft-Versus-Host Disease After Deceased-Donor Liver Transplantation: A Case Report.

    Kim MJ, Ahn KS, Kim TS, et al.

    The American journal of case reports 2026; (27()):e951031 doi:10.12659/AJCR.951031.

    PMID: 41655010
  14. 14

    Evaluation of the lower histologic threshold for gastric graft versus host disease.

    Mostafa M, Hartley CP, Hagen CE

    Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 2020; (33(5)):962-970 doi:10.1038/s41379-019-0421-7.

    PMID: 31857676
  15. 15

    Patient-reported symptom burden of chronic graft versus host disease: a systematic literature review.

    Csanádi M, Ágh T, Farkas-Ráduly S, et al.

    Expert review of hematology 2020; (13(10)):1119-1130 doi:10.1080/17474086.2020.1818065.

    PMID: 32865071
  16. 16

    Systematic Review of Patient-Reported Outcome Measures in Graft-versus-Host Disease.

    Kilgour JM, Wali G, Gibbons E, et al.

    Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 2020; (26(5)):e113-e127 doi:10.1016/j.bbmt.2020.01.022.

    PMID: 32028026

This page explains GVHD symptoms for educational purposes only. Always report new symptoms to your transplant team immediately and seek emergency care for any fever.

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