What is the classic triad of acute graft-versus-host disease manifestations?

• A. Rash on palms/soles, liver dysfunction with rising bilirubin, and profuse watery diarrhea
• B. Cough, chest pain, night sweats
• C. Jaundice only
• D. Arthritis and trunk rash

Answer: (A)

Acute graft-versus-host disease after an allogeneic transplant classically involves three organ systems: the skin, the liver, and the gastrointestinal tract. The skin reaction is often a maculopapular rash that can spread beyond the trunk and may involve the palms and soles. The liver shows dysfunction with rising bilirubin reflecting cholestasis and hepatic injury. The gastrointestinal tract is characteristically affected with profuse watery diarrhea due to intestinal involvement. Taken together, rash, elevated bilirubin with liver dysfunction, and severe diarrhea represent the classic triad of acute GVHD. Other options describe symptoms limited to a single organ, or non-specific symptoms, which do not capture this multi-organ pattern.