Bilateral pneumothoraces with multiple bullae in a patient with asymptomatic bronchiolitis obliterans 10 years after bone marrow transplantation

Abstract

Summary:A 16-year-old boy developed bronchiolitis obliterans (BO) 10 years after BMT for myelodysplastic syndrome. Although the patient complained of almost no dyspnea on exertion, he had mild hypercapnea with a markedly reduced forced expiratory volume of 0.32 l. Chest Xrays showed occasional bilateral minimal pneumothoraces, which is in accordance with the existence of multiple small bullae found on the pleural surface at videoassisted thoracic surgery. Histologic examination of the biopsied lung revealed BO. This case indicates that BO in adolescence following BMT and possible chronic GVHD may be masked because of lung immaturity at BMT, and BO after BMT may be associated with multiple pleural bullae. Keywords: bronchiolitis obliterans; BMT; pneumothorax; GVHD Bronchiolitis obliterans (BO) is a localized inflammatory process of the bronchioles featuring fibrotic obliteration of the lumen. BO is a characteristic pulmonary complication which occurs usually within a few years after BMT. [1][2][3] We report a patient with asymptomatic BO and bilateral pneumothoraces caused by multiple bullae after BMT. Case reportA 16-year-old male was referred to our outpatient clinic because of abnormal shadows after a routine chest radiogram despite no respiratory symptoms (Figure 1a). At the age of 6, he had been diagnosed with myelodysplastic syndrome, for which he had received an allogeneic BMT from his HLA-matched sister after a preparative regimen with a total of 12 Gy TBI in six fractions and CY at a dose of

Pleuroparenchymal Fibroelastosis as a Series of Airway Complications Associated with Chronic Graft-versus-host Disease following Allogeneic Bone Marrow Transplantation

“…Both the present case and previous reports appear to support a 3-to 24-month presentation time of BO (3,5,6). In contrast, the presentation time for pneumothorax and PPFE ranges from two to 16 years (7,8,13).…”

Spontaneous pneumomediastinum and subcutaneous emphysema complicating bronchiolitis obliterans after allogeneic bone marrow transplantation – case report and review of literature

“…It is almost never seen during the first hundred days after transplantation. Bronchiolitis obliterans has been diagnosed as late as ten years after transplantation [12]. The disease onset is usually characterized by dyspnea, productive cough, and, sometimes, wheezing, which can be rapidly progressive.…”

Mediastinal emphysema and bilateral pneumothoraces with chronic GVHD in patients after allogeneic stem cell transplantation

“…[6][7][8][9][10][11][12][13][14][15] The first detailed report of IP after BMT was a report by Neiman et al in 1973, 6 and an association between IP and allogeneic marrow grafts and GVHD was noted. On the other hand, ME and BP after allo-SCT are rare complications, [16][17][18][19][20][21][22][23][24][25][26] and ME and BP with chronic GVHD after allo-SCT are extremely rare, [19][20][21][24][25][26] only seven cases having been reported. Characteristics of these cases are summarized in Table 2.…”

“…[16][17][18][19][20][21][22][23][24][25][26] We reported five cases of ME and BP associated with chronic GVHD.…”