Background: Autologous stem cell transplantation is an alternative to allogeneic stem cell transplantation to minimize the complications of genetic discrepancies in mismatching donor cells to the recipient. One such complication, graft-versus-host-disease (GVHD), should theoretically not occur with autologous transplantation given the identical similarity in cells. The literature supporting GVHD in these patients is reviewed and a case presentation of insidious GVHD is demonstrated to emphasize awareness of this elusive disease. A timely and accurate diagnosis can minimize unnecessary hospitalizations, repetitive infectious disease evaluations and maximize utmost patient care in autologous stem cell transplantation patients.

Objective: This case highlights the incidence of graft-versus-host disease occurring in this unique patient population and serves to help elucidate the mechanisms behind this autogenic phenomenon.

Case Description: The patient is a sixty-six-year-old man with a history of multiple myeloma and recent autologous stem cell transplantation who developed a non-specific cutaneous eruption in the setting of refractory diarrhea. The patient was admitted for further work-up and hypothesized to have autologous GVHD readily responsive to steroid therapy.

Conclusions: This case report and literature review highlights the necessary cognizance and recognition of the phenomenon of autologous GVHD. The presentation occurs early after ASCT with non-specific gastrointestinal and cutaneous findings. Misdiagnosis can result in a lack of appropriate treatment and unnecessary hospitalizations. GVHD presenting in autologous stem cell transplantation patients is an elusive diagnosis which should be swiftly recognized and treated.