OSCE — Graft-versus-host disease (GVHD) — cutaneous manifestations

Brief (to candidate)

You will assess a patient with a presentation consistent with Graft-versus-host disease (GVHD) — cutaneous manifestations.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Graft-versus-host disease (GVHD) is a multisystem complication of allogeneic haematopoietic stem cell transplantation (HSCT) in which donor T-lymphocytes attack host HLA-mismatched tissues — primarily the skin, gastrointestinal tract, and liver. Acute GVHD (classically ≤100 days post-transplant) presents with an acral maculopapular rash (Stage I less than 25% BSA → Stage IV bullae/desquamation, TEN-like), GI symptoms (secretory/bloody diarrhoea), and cholestatic hepatitis. Chronic GVHD (classically >100 days, NIH-defined by clinical features) presents with lichenoid (lichen planus-like) or sclerodermoid (morphea/SSc-like) cutaneous changes, oral mucositis, sicca syndrome, bronchiolitis oblit

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]