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Oh, Kim, Kim, Hyun, Lee, Bae, Jung, and Kwon: Improvement of Pulmonary Function after Administration of Azithromycin in a Patient with Bronchiolitis Obliterans: a Case Report
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 65(5): 410-415.

Published online: 30 November 2008

DOI: https://doi.org/10.4046/trd.2008.65.5.410

Improvement of Pulmonary Function after Administration of Azithromycin in a Patient with Bronchiolitis Obliterans: a Case Report

Ji Hye Oh, M.D.1, Kyung Chan Kim, M.D.1, Sung Woo Kim, M.D.1, Dae Sung Hyun, M.D.1, Sang Chae Lee, M.D.1, Sung Hwa Bae, M.D.1, Kyung Jae Jung, M.D.2, Kun Young Kwon, M.D.3

1Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

2Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea.

3Department of Pathology, Keimyung University School of Medicine, Daegu, Korea.

Address for correspondence: Kyung Chan Kim, M.D. Department of Internal Medicine, Catholic University of Daegu School of Medicine, 3056-6, Daemyung 4-dong, Nam-gu, Daegu 705-718, Korea. Phone: 82-53-650-4294, Fax: 82-53-622-2072solarmac@cu.ac.kr

Received 27 July 2008       Accepted 16 September 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Bronchiolitis obliterans (BO) is a serious noninfectious complication following an allogeneic bone marrow transplant (BMT). A 21-year-old female received an allogeneic BMT as a treatment for myelodyplastic syndrome. Four months after the BMT, progressive dyspnea developed and BO was also diagnosed by a lung biopsy. The patient was administered steroid and immunosuppressive agents for 1 year but there was no improvement in pulmonary function. Azithromycin was prescribed (500 mg q.d. for 3 days followed by 250 mg three time a week) because macrolides might decrease the inflammatory reaction leading to BO. The patient's pulmonary function improved after administration of azithromycin for 1 year. The forced expiratory volume in a one second (FEV1) increase was 220 mL (28.2%) and the forced vital capacity (FVC) increase was 460 mL (25.7%). We report the improvement in the pulmonary function after the administration of azithromycin for 1 year in a patient with BO after a BMT.

Keywords: Bone marrow transplantation, Bronchiolitis obliterans, Pulmonary function, Azithromycin

Figures and Tables

Figure 1
PA view shows no parenchymal abnormality in both lungs. PA: pulmonary artery.
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Figure 2
Chest HRCT image at the level of inferior pulmonary vein shows subtle hyperlucency of right middle and both lower lobes, which was more evident on images taken during expiration (not shown) (A) and bronchial dilation (long arrow) and circumferential bronchial wall thickening (short arrow) are seen at the level of left ventricle (B).
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Figure 3
(A) The bronchiole shows markedly fibro-inflammatory thickening of the wall (long arrow) and prominent narrowing of the lumen. The adjacent lung parenchyma shows focal emphysematous change with rupture of the alveolar walls (short arrows) (H&E stain, ×40). (B) The constricted bronchiole shows markedly proliferated smooth muscle bundles (long arrows) and slit-like narrowed lumen with loss of the bronchiolar epithelium (short arrow) (H&E stain, ×100).
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Table 1
Results of the serial spirometric measurement
trd-65-410-i001

BMT: bone marrow transplantation; BO: bronchiolitis obliterans; L: liter; FEV1: forced expiratory volume in one second; FVC: forced vital capacity.

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