DDX of gastrointestinal complications of bone marrow transplantation

Approach to the DDX of gastrointestinal complications of bone marrow transplantation (BMT):

  • Timing: Graft versus host disease + typhlitis occur up to 30 days after BMT, pseudomembranous colitis occurs any time after BMT
  • Sites: Graft versus host disease involves esophagus to rectum, typhlitis involves terminal ileum / cecum / ascending colon, pseudomembranous colitis involves entire colon
  • Imaging: Graft versus host disease has mild bowel wall thickening and halo sign, typhlitis has moderate bowel wall thickening and pneumatosis, pseudomembranous colitis has marked bowel wall thickening and accordion sign
  • Clinical: Graft versus host disease has skin / liver / spleen / gall bladder involvement, typhlitis has decreased white blood cell count, pseudomembranous colitis has positive Clostridium difficile toxin