Lymphocytic pneumonitis as the manifestation of acute graft-versus-host disease of the lung

✍ Scribed by Javier Bolaños-Meade; Olga Ioffe; Jamie C. Hey; Georgia B. Vogelsang; Görgün Akpek

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 128 KB
• Volume: 79
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.20315

✦ Synopsis

Abstract

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. Am. J. Hematol. 79:132–135, 2005. © 2005 Wiley‐Liss, Inc.