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Jung, Sung, Lee, Han, Shin, Park, and Kim: A Case of Nonclassifiable Interstitial Pneumonia after Allogeneic Hematopoietic Stem Cell Transplantation
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 66(2): 122-126.

Published online: 28 February 2009

DOI: https://doi.org/10.4046/trd.2009.66.2.122

A Case of Nonclassifiable Interstitial Pneumonia after Allogeneic Hematopoietic Stem Cell Transplantation

Ki Hwan Jung, M.D.1, Hwa Jung Sung, M.D.1, Ju-Han Lee, M.D.2, Joungho Han, M.D.3, Chol Shin, M.D.1, Hyung Joo Park, M.D.4, Je Hyeong Kim, M.D.1

1Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.

2Department of Pathology, Korea University Ansan Hospital, Ansan, Korea.

3Department of Pathology, Saumsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

4Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Ansan, Korea.

Address for correspondence: Je Hyeong Kim, M.D. Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, 516, Gojan-1-dong, Danwon-gu, Ansan 425-707, Korea. Phone: 82-31-412-5950, Fax: 82-31-413-5950, chepraxis@korea.ac.kr

Received 23 December 2008       Accepted 19 January 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Despite the improvements in supportive care, early and late hematopoietic stem cell transplantation-related complications still remain a significant cause of morbidity and mortality. Pulmonary complications occur in 40~60% of patients who undergo allogeneic hematopoietic stem cell transplantation. Late-onset noninfectious pulmonary complications can occur months and even years after transplantation. Interstital lung disease has also been reported to be a late post-transplant complication. Exposure to cytotoxic drugs and/or irradiation has been implicated as a cause of pulmonary toxicity including pulmonary fibrosis. We report a case of an 18-year-old female with non-classifiable interstitial pneumonia that manifested eight and a half years after allogeneic hematopoietic stem cell transplantation. The condition worsened rapidly and the patient eventually died.

Keywords: Hematopoietic stem cell transplantation, Interstitial lung disease, Pneumothorax

Figures and Tables

Figure 1
Chest radiograph on admission (A) showed reticulonodular opacities on both upper lung zones and patchy opacities with consolidation on left mid to lower lung zone. After 2 months (B), recurrent pneumothoraxes were developed and progressive bilateral haziness worsened until 5 months after admission (C), resulting in death.
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Figure 2
High resolution computed tomography of chest on admission showed reticulonodular opacities on both upper lobes (A), ground glass opacity with consolidation on left lower lobe (B) and aggravated air cysts on right lower lobe (C).
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Figure 3
Histopathology of the resected left lower lobe revealed chronic inflammation with alveolar macrophages in alveolar space and focal interstitial fibrosis. Subpleural and peribronchiolar collagen type fibrosis with some lymphocytic infiltration was seen (H&E stain, A: ×200, B: ×400).
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References

1. Yen KT, Lee AS, Krowka MJ, Burger CD. Pulmonary complications in bone marrow transplantation: a practical approach to diagnosis and treatment. Clin Chest Med. 2004. 25:189–201.
2. Eikenberry M, Bartakova H, Defor T, Haddad IY, Ramsay NK, Blazar BR, et al. Natural history of pulmonary complications in children after bone marrow transplantation. Biol Blood Marrow Transplant. 2005. 11:56–64.
3. Palmas A, Tefferi A, Myers JL, Scott JP, Swensen SJ, Chen MG, et al. Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation. Br J Haematol. 1998. 100:680–687.
4. Michelson PH, Goyal R, Kurland G. Pulmonary complications of haematopoietic cell transplantation in children. Paediatr Respir Rev. 2007. 8:46–61.
5. Yabe M, Yabe H, Hattori K, Morimoto T, Hinohara T, Takakura I, et al. Fatal interstitial pulmonary disease in a patient with dyskeratosis congenita after allogeneic bone marrow transplantation. Bone Marrow Transplant. 1997. 19:389–392.
6. Yoshihara S, Yanik G, Cooke KR, Mineishi S. Bronchiolitis obliterans syndrome (BOS), bronchiolitis obliterans organizing pneumonia (BOOP), and other late-onset noninfectious pulmonary complications following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2007. 13:749–759.
7. Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2004. 170:22–48.
8. Lim DH, Lee J, Lee HG, Park BB, Peck KR, Oh WS, et al. Pulmonary complications after hematopoietic stem cell transplantation. J Korean Med Sci. 2006. 21:406–411.
9. Khurshid I, Anderson LC. Non-infectious pulmonary complications after bone marrow transplantation. Postgrad Med J. 2002. 78:257–262.
10. Ahn CM, Hwang SY, Byun MK, Lee JH, Chung WY, Moon JW, et al. Recurrent secondary pneumothorax caused by bronchiolitis obliterans due to chronic graft versus host disease in a patient with chronic myelogenous leukemia after allogenic bone marrow transplantation. Tuberc Respir Dis. 2004. 57:183–187.
11. Gosselin MV, Adams RH. Pulmonary complications in bone marrow transplantation. J Thorac Imaging. 2002. 17:132–144.
12. Wah TM, Moss HA, Robertson RJ, Barnard DL. Pulmonary complications following bone marrow transplantation. Br J Radiol. 2003. 76:373–379.
13. Griese M, Rampf U, Hofmann D, Führer M, Reinhardt D, Bender-Götze C. Pulmonary complications after bone marrow transplantation in children: twenty-four years of experience in a single pediatric center. Pediatr Pulmonol. 2000. 30:393–401.
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