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Case 5A and 5B
Presented by: Dr. F. Calabrese
Clinical History
A 19 year old male patient affected by high-risk anaplastic large cell lymphoma (first diagnosis at age 7) underwent allogenic bone-marrow transplant from an HLA-matched urelted donor at age 12 in complete remission of his underlying disease after 4 relapses. The myeloablative conditioning regimen was based on total irradiation (12 Gy), cyclophosfamide ( 120 mg/kg) and thiotepa ( 10mg/kg). GVHD prophylaxis was performed with the administration of rabbit polyclonal antilymphocyte serum and cyclosporin plus short methotrexate respectively before and after stem cell infusion. One month after transplantation the patient developed erythematous macules with the greatest concentration on his superior chest. From age 13 he presented dyspnea on exertion, wheezing and productive cough. Chest X-ray showed reticular shadow and lung function test showed a decrease of FEV1 ( 42%) with a progressive worsening . The HR-CT of chest presented a mosaic pattern. Transbronchial biopsy (TBB) was performed at age 16. Due to progressive lung dysfunction, bilateral lung transplantation was performed at age 17. The patient is currently alive, discharged home.
A: TTB
B:Lung sections from native lungs.
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A) Constrictive bronchiolitis (transbronchial biopsy-TBB)
B) Constrictive bronchiolitis + Aspergillus infection (native lung)
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GVHD |
2.9.2007 |
Shirin Karimi, MD |
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28.12.2007 |
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