Szlauer-Stefańska Anastazja, Krawczyk-Kuliś Małgorzata, Kamińska-Winciorek Grażyna, Bobek-Billewicz Barbara, Giebel Sebastian
Bone Marrow Transplantation and Oncohematology Department, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland.
Bone Marrow Transplantation and Oncohematology Department, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland.
Transplant Proc. 2020 Oct;52(8):2551-2553. doi: 10.1016/j.transproceed.2020.01.123. Epub 2020 May 19.
We present a case of a young patient with life-threatening pulmonary complications after allogeneic hematopoietic stem cell transplantation (HSCT). The 25-year-old woman, after HSCT for multiple myeloma, developed severe chronic graft-vs-host disease (GvHD), including bronchiolitis obliterans syndrome. During the treatment of chronic GvHD, 18 months after HSCT, she experienced sudden massive pulmonary hemorrhage with cardiac arrest. The computed tomography imaging revealed lesions suggestive of fungal etiology, with cavity adjacent to the pulmonary vessels. Disqualified from invasive treatment due to poor pulmonary performance, she was treated conservatively with broad-spectrum antibiotics and antifungals. The microbiological workup consistently revealed only Pseudomonas aeruginosa colonization. Her condition steadily improved on treatment. Over 18 months after the incident, she did not experience recurrent bleeding nor serious infection, her primary disease remains in remission, and GvHD symptoms are controlled. Allogeneic HSCT offers possibility of sustained immune-mediated disease control and sometimes even cure, but despite reduced transplant related mortality, GvHD and infections may be detrimental for transplant recipients. Our report illustrates atypical manifestation of pulmonary lesions and highlights the importance of infection control during GvHD treatment.
我们报告一例年轻患者，在异基因造血干细胞移植（HSCT）后出现危及生命的肺部并发症。这位25岁的女性在接受多发性骨髓瘤的HSCT后，发生了严重的慢性移植物抗宿主病（GvHD），包括闭塞性细支气管炎综合征。在HSCT后18个月的慢性GvHD治疗期间，她突然发生大量肺出血并心脏骤停。计算机断层扫描成像显示病变提示真菌病因，肺血管旁有空洞。由于肺部功能差而不适合进行侵入性治疗，她接受了广谱抗生素和抗真菌药物的保守治疗。微生物学检查始终仅显示铜绿假单胞菌定植。她的病情在治疗后稳步改善。事件发生18个月后，她没有再次出血7也没有发生严重感染，她7原发性疾病仍处于缓解期，GvHD症状7得到控制。异基因HSCT提供了持续免疫介导的疾病控制甚至7治愈7可能性7但尽管移植相关死亡率降低，GvHD和感染可能对移植受者有害。我们的报告说明了肺部病变的非7典型表现，并强调了GvHD治疗期间感染7控制777重要性。
