Exacerbation of Pulmonary Fibrosis Following Single Lung Transplantation

Dawei Yang,Robert D Levy,Jennifer M Wilson,Chunxue Bai,Nasreen Khalil,Pearce G Wilcox,John Yee

doi:10.1155/2012/258485

Abstract

Acute exacerbations of interstitial lung disease present as clinical deteriorations, with progressive hypoxemia and parenchymal consolidation not related to infection, heart failure or thromboembolic disease. Following single lung transplantation, patients receive maintenance immunosuppression, which could mitigate the development of acute exacerbations in the native lung. A 66-year-old man with fibrotic, nonspecific interstitial pneumonitis presented with fever, hypoxemia and parenchymal consolidation limited to the native lung four years after single lung transplantation. Investigations were negative for infection, heart failure and thromboembolic disease. The patient worsened over the course of one week despite broad-spectrum antimicrobial therapy, but subsequently improved promptly with augmentation of prednisone dosed to 50 mg daily and addition of N-acetylcysteine. Hence, the patient fulfilled the criteria for a diagnosis of an acute exacerbation of pulmonary fibrosis in his native lung. Clinicians should consider acute exacerbation of parenchymal lung disease of the native lung in the differential diagnosis of progressive respiratory deterioration following single lung transplantation for pulmonary fibrosis.

Highlights

Acute exacerbations of interstitial lung disease present as clinical deteriorations, with progressive hypoxemia and parenchymal consolidation not related to infection, heart failure or thromboembolic disease
The patient was admitted to hospital with presumed sion, which could prevent the development of acute exacerbations in pneumonia and was started on intravenous meropenem, vancomycin the native lung
A high-resolution computed tomography (HRCT) scan of his chest showed diffuse ground-glass opacification throughout the left native lung along with stable findings of NSIP (Figure 1B), and findings in the right lung allograft were unchanged when compared with a surveillance HRCT performed three months earlier (Figure 1A)

Summary

Introduction

Acute exacerbations of interstitial lung disease present as clinical deteriorations, with progressive hypoxemia and parenchymal consolidation not related to infection, heart failure or thromboembolic disease. Après la greffe d’un seul poumon, les patients reçoivent une immunosuppression d’entretien, qui pourrait atténuer l’apparition d’exacerbations aiguës du poumon natif. Les cliniciens devraient envisager une exacerbation aiguë de la maladie pulmonaire parenchymateuse du poumon natif dans le diagnostic différentiel de la détérioration respiratoire évolutive après la greffe d’un poumon en traitement d’une fibrose pulmonaire.

Results

Conclusion