Sato Shuku, Tanaka Eri, Tachibana Takayoshi, Fukai Ryuta, Kamio Tadashi, Ichiba Shingo, Sato Masaaki, Tamai Yotaro
Division of Hematology, Shonan Kamakura General Hospital.
Internal Medicine, Hayama Heart Center.
Rinsho Ketsueki. 2019;60(8):920-923. doi: 10.11406/rinketsu.60.920.
A 29-year-old man was diagnosed with acute myeloid leukemia at 20 years of age; he achieved a second complete remission at 22 years of age after an allogeneic unrelated bone marrow transplantation. After 14 months, he developed bronchiolitis obliterans (BO) due to chronic graft-versus-host disease. Home ventilator management was continuously performed for 3 years, but the patient required extracorporeal membrane oxygenation (ECMO) after progression to type 2 respiratory failure. A matched brain-dead lung donor was found after 5 months of intensive care management on ECMO, and bilateral lung transplantation was successfully performed. BO is a progressive refractory respiratory disease with poor prognosis. Careful management of infection, monitoring organ function, and lung transplantation at the appropriate time of initiation of mechanical ventilation or ECMO may save a patient's life. However, it is crucial to collaborate with higher education institutions or medical professionals in other departments.
一名29岁男性在20岁时被诊断为急性髓系白血病;22岁时接受异基因非亲属骨髓移植后实现第二次完全缓解。14个月后,他因慢性移植物抗宿主病发展为闭塞性细支气管炎(BO)。持续进行家庭通气管理3年,但患者进展为2型呼吸衰竭后需要体外膜肺氧合(ECMO)。在接受ECMO强化治疗管理5个月后找到了一名匹配的脑死亡肺供体,并成功进行了双侧肺移植。BO是一种预后不良的进行性难治性呼吸系统疾病。在机械通气或ECMO开始的适当时间仔细管理感染、监测器官功能并进行肺移植可能挽救患者生命。然而,与高等教育机构或其他科室的医学专业人员合作至关重要。