Thoracic Air Leak Syndrome: A Rare and Fatal Complication of Allogeneic Stem Cell Transplant

Abdullah Sakkat,Shariq Haider,Matthew Patel

doi:10.4236/crcm.2020.94013

Abstract

Thoracic air leak syndrome (TALS) is a rare complication of allogeneic stem cell transplant (Allo-SCT) and is associated with a poor prognosis. We report a case of a 67-year-old male, after 20 months of Allo-SCT for acute myeloid leukemia, who presented with fever and acute worsening dyspnea on a background of a 4-month history of slowly progressive dyspnea. He was initially diagnosed with parainfluenza pneumonia and later developed TALS as a result of bronchiolitis obliterans (BO) caused by chronic graft-versus-host disease (cGVHD). Herein, we highlight the importance of early recognition and treatment of non-infectious pulmonary complications of Allo-SCT.

Highlights

Allogeneic stem cell transplant (Allo-SCT) is the treatment of choice for many malignant and nonmalignant hematological disorders
He was initially diagnosed with parainfluenza pneumonia and later developed Thoracic air leak syndrome (TALS) as a result of bronchiolitis obliterans (BO) caused by chronic graft-versus-host disease
This study identified multiple risk factors for BO and found that chronic graft-versus-host disease is the most important risk factor leading to a rise in the prevalence rate to 14% [4]

Summary

Introduction

Allogeneic stem cell transplant (Allo-SCT) is the treatment of choice for many malignant and nonmalignant hematological disorders. Bronchiolitis obliterans (BO) is a late non-infectious pulmonary complication post Allo-SCT with a reported prevalence rate of 5.5% in one study enrolled 1145 patients. This study identified multiple risk factors for BO and found that chronic graft-versus-host disease (cGVHD) is the most important risk factor leading to a rise in the prevalence rate to 14% [4]. The etiology of BO post Allo-SCT remains unclear. The mechanism of TALS is unknown but thought to be caused by the rupture of the alveoli leading to interstitial emphysema, which leads to air travel along the bronchovascular sheath to the mediastinum [6]. The real incidence of TALS in patients with BO remains unclear due to the lack of reported cases. Multiple risk factors have been identified for TALS post Allo-SCT. We report a case of TALS in a patient with BO and describe imaging findings, pulmonary function tests (PFTs) results and clinical course

Case Presentation

Discussion

Conclusion

Findings

Sakkat et al DOI