Lymphocytic pneumonitis as the manifestation of acute graft-versus-host disease of the lung.
Acute graft-versus-host disease is a common complication after allogeneic stem cell transplantation. It normally affects the skin, liver, and gut. We report a 54-year-old male who developed shortness of breath, cough, and bilateral pulmonary infiltrates in which the work-up failed to demonstrate an infectious etiology 165 days post-HLA-matched allogeneic peripheral blood stem cell transplant. Eighteen days before, his tacrolimus had been tapered and it was subtherapeutic on admission. A transbronchial biopsy showed a perivascular and interstitial lymphocytic infiltrate without evident pathogens on histology or extensive work-up. The clinical picture was suggestive of pulmonary acute graft-versus-host disease. No disease was present elsewhere. Accordingly, the patient was treated with steroids and tacrolimus. After 12 hr on methylprednisolone, his symptoms disappeared with eventual resolution radiologically. Acute graft-versus-host disease of the lung is a very uncommon complication after stem cell transplant, but it should be considered in patients who are at high risk for graft-versus-host disease or developing symptoms soon after discontinuing immunosuppression. Its diagnosis requires work-up to rule out an infectious etiology and a biopsy to confirm histology.
Bolaños-Meade
Javier
J
Blood and Marrow Transplant Program, University of Maryland Greenebaum Cancer Center, Baltimore, Maryland, USA. Fbolano2@jhmi.edu
Ioffe
Olga
O
Hey
Jamie C
JC
Vogelsang
Georgia B
GB
Akpek
Görgün
G
D000208:Acute Disease; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000150:complications* / Q000188:drug therapy; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D013902:Radiography, Thoracic; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D016559:Tacrolimus; D008775:Methylprednisolone