title: A precious experience of lobar transplantation in a teenager with end-stage chronic hypersensitivity pneumonia: case report.
abstract: Pulmonary fibrosis inevitably develops in patients with chronic hypersensitivity pneumonia (CHP). Lobar transplantation may be a viable option for pediatric and small adult patients with end-stage CHP and life-threatening respiratory decompensation. We describe a 16-year-old girl experiencing end-stage pigeon breeder's hypersensitivity pneumonia with right heart failure, who received left allograft lobar transplantation and had an uneventful convalescent course for 1 year after transplantation. Histopathologically the excised native lung revealed diffuse infiltration of lung parenchyma by CD3+ and CD8+ cells with an absence of CD4+ cells, whereas T-lymphocyte subsets analysis revealed no abnormalities in the blood. This finding is consistent with the contribution of a local type IV immune reaction to the pathogenesis. In addition, the observation of specific cellular distribution of bronchus-associated lymphoid tissue suggests that chronic antigenic stimulation and /or inflammation in CHP may cause bronchus-associated lymphoid tissue development, which is likely to play an important role in the mucosal immune response of this disease.
authors.affiliation: Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Y-L
authors.initials: YL
authors.lastname: Chang
authors.forename: C-T
authors.initials: CT
authors.lastname: Wu
authors.forename: P-M
authors.initials: PM
authors.lastname: Huang
authors.forename: H-S
authors.initials: HS
authors.lastname: Shu
authors.forename: Y-C
authors.initials: YC
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000818:Animals; D010856:Columbidae; D005260:Female; D006801:Humans; D006967:Hypersensitivity; D016040:Lung Transplantation / Q000379:methods / Q000473:pathology*; D011014:Pneumonia / Q000276:immunology* / Q000473:pathology / Q000601:surgery*; D013902:Radiography, Thoracic