RESUMO
Acute graft-versus-host disease is a common complication after allogeneic stem cell transplantation. It normally affects the skin, liver, and gut. We report a 54-year-old male who developed shortness of breath, cough, and bilateral pulmonary infiltrates in which the work-up failed to demonstrate an infectious etiology 165 days post-HLA-matched allogeneic peripheral blood stem cell transplant. Eighteen days before, his tacrolimus had been tapered and it was subtherapeutic on admission. A transbronchial biopsy showed a perivascular and interstitial lymphocytic infiltrate without evident pathogens on histology or extensive work-up. The clinical picture was suggestive of pulmonary acute graft-versus-host disease. No disease was present elsewhere. Accordingly, the patient was treated with steroids and tacrolimus. After 12 hr on methylprednisolone, his symptoms disappeared with eventual resolution radiologically. Acute graft-versus-host disease of the lung is a very uncommon complication after stem cell transplant, but it should be considered in patients who are at high risk for graft-versus-host disease or developing symptoms soon after discontinuing immunosuppression. Its diagnosis requires work-up to rule out an infectious etiology and a biopsy to confirm histology.
Assuntos
Doença Enxerto-Hospedeiro/complicações , Pneumopatias/complicações , Linfócitos/patologia , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Pneumonia/etiologia , Pneumonia/patologia , Doença Aguda , Anti-Inflamatórios/uso terapêutico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Leucemia Mieloide Aguda/terapia , Pulmão/patologia , Pneumopatias/tratamento farmacológico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Pneumonia/diagnóstico por imagem , Pneumonia/tratamento farmacológico , Radiografia Torácica , Esteroides/uso terapêutico , Tacrolimo/uso terapêutico , Tomografia Computadorizada por Raios X , Transplante HomólogoAssuntos
Hipertensão Pulmonar/terapia , Anti-Hipertensivos/uso terapêutico , Bosentana , Bloqueadores dos Canais de Cálcio/uso terapêutico , Endotelinas/antagonistas & inibidores , Epoprostenol/análogos & derivados , Humanos , Hipertensão Pulmonar/classificação , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Sulfonamidas/uso terapêutico , Vasodilatadores/uso terapêuticoRESUMO
Lung cancer is one of the most common causes of death in elderly patients in the United States. Treatment advances have improved survival in selected patients. The available treatments carry the risk of morbidity and mortality but the benefit in most patients far outweighs the risks, given the dismal prognosis of untreated disease. Elderly patients with lung cancer need careful attention during pretreatment assessment. Advanced age alone, however, should not contraindicate aggressive treatment. In the high-risk groups it is important to involve a team of physicians including surgeons, radiation oncologists, medical oncologists, and pulmonologists, who are familiar with current treatment options and their risks.
