An unusual cause of respiratory failure in a 25-year-old heart and lung transplant recipient.
A 25-year-old woman, a never smoker with a history of heart-lung transplantation for World Health Organization group 1 pulmonary arterial hypertension performed 20 months prior to presentation, was evaluated for shortness of breath. Following transplantation, she was initiated on standard therapy of prednisone, tacrolimus, and azathioprine, along with routine antimicrobial prophylaxis. Her posttransplant course was complicated by persistent acute cellular rejection, as determined from a transbronchial biopsy specimen, without evidence of rejection in an endomyocardial biopsy specimen. The immunosuppressive medications were supplemented with pulse-dosed steroids, and the patient was transitioned from azathioprine to mycophenolate mofetil. Sirolimus was added 9 months prior to presentation. Three months prior to presentation, she was admitted for increasing oxygen requirements, shortness of breath, and bilateral infiltrates on the CT scans of the chest.
Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Sarah
S
Narotzky
Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Cassie Colleen
CC
Kennedy
Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: maldonado.fabien@mayo.edu.
Fabien
F
Maldonado
D000328:Adult; D005260:Female; D016041:Heart-Lung Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis*; D011649:Pulmonary Alveolar Proteinosis / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis*; D012131:Respiratory Insufficiency / Q000209:etiology; D020123:Sirolimus / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D020123:Sirolimus