Richard C, Calavia J, Loyola I, Baró J, Cuadrado M A, Gómez-Casares M T, Zurbano F, Ondiviela R, Zubizarreta A
Servicio de Hematología, Hospital Nacional Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander.
Med Clin (Barc). 1994 Apr 2;102(12):462-4.
A 39 year old patient diagnosed of severe aplastic anemia and treated with allogenic bone marrow transplantation and who presented chronic eosinophilic pneumonia eight months after the transplant is presented. The patient had no previous history of asthma or atopy. Conditioning was performed with cyclophosphamide and total body irradiation. Prophylaxis of the graft versus host disease was carried out with cyclosporin and short course of methotrexate. At day 30 mild graft versus host disease appeared which spontaneously resolved. A progressive increase in the number of eosinophils was observed from day +40 reaching 1.05 x 10(9)/l at day +180 coinciding with suspension of the cyclosporine. The patient remained asymptomatic with no evidence of chronic graft versus host disease. At 8 months following allogenic transplantation the patient developed three episodes of fever, cough, moderate dyspnea and pulmonary infiltrates. Respiratory tests showed a restrictive pattern. Bronchoalveolar lavage contained 20% of eosinophils. Upon lung biopsy alveolar infiltration by eosinophils, lymphocytes and mononuclear cells was observed. Diagnosis of chronic eosinophilic pneumonia was made with initiation of steroid treatment. A drastic response was observed. The patient remained asymptomatic without recurrence and without evidence of chronic graft versus host disease. This picture may have been caused by the donor eosinophils given that retrospective evaluation demonstrated a persistent moderate eosinophilia in the donor.
报告一名39岁诊断为严重再生障碍性贫血并接受同种异体骨髓移植治疗的患者，该患者在移植后8个月出现慢性嗜酸性粒细胞性肺炎。患者既往无哮喘或特应性病史。预处理采用环磷酰胺和全身照射。移植物抗宿主病的预防采用环孢素和短疗程甲氨蝶呤。在第30天出现轻度移植物抗宿主病，后自发缓解。从第40天起观察到嗜酸性粒细胞数量逐渐增加，在第180天达到1.05×10⁹/L，此时恰逢环孢素停用。患者无症状，无慢性移植物抗宿主病的证据。在同种异体移植后8个月，患者出现三次发热、咳嗽、中度呼吸困难和肺部浸润发作。呼吸检查显示为限制性模式。支气管肺泡灌洗中嗜酸性粒细胞占20%。肺活检显示肺泡有嗜酸性粒细胞、淋巴细胞和单核细胞浸润。诊断为慢性嗜酸性粒细胞性肺炎并开始使用类固醇治疗。观察到显著疗效。患者无症状，无复发，无慢性移植物抗宿主病的证据。鉴于回顾性评估显示供体持续存在中度嗜酸性粒细胞增多，这种情况可能是由供体嗜酸性粒细胞引起的。
