Denuded bowel after recovery from graft-versus-host disease

Graft-versus-host disease (GVHD) is a common complication of bone marrow transplantation and often involves the gastrointestinal system. It is unclear whether there can be severe enough damage by GVHD to permanently injure the bowel and thereby prevent mucosal regeneration. We describe a patient who had successful treatment of GVHD, but who had such severe scarring of the bowel mucosa that the colonic epithelium could not regenerate even 50 days after biopsy-demonstrated resolution of GVHD. Surveillance cultures and histological analysis indicate that this denudation was not caused by infection or continued GVHD. This is an important observation with implications for monitoring response to GVHD therapy and using rectal biopsy to evaluate GVHD.