CHEST Guidelines-A-48-Year-Old-Man-With-Leukopenia,-Jaundice,-and-S

A-48-Year-Old-Man-With-Leukopenia,-Jaundice,-and-S

Pdf Summary

This medical case study discusses a 48-year-old African-American male who developed graft-versus-host disease (GVHD) after undergoing a bilateral lung transplantation. Initially performed to treat advanced pulmonary sarcoidosis, the transplant procedure and immediate postoperative course were uneventful, with common immunosuppressants prescribed. Twelve weeks post-surgery, the patient presented with progressive fatigue, jaundice, and leukopenia.<br /><br />The patient's leukopenia and jaundice were initially suspected to be adverse effects from medications, resulting in adjustments to his drug regimen, including holding mycophenolate mofetil and discontinuing others. Despite interventions, the patient’s condition worsened, and he developed pancytopenia, rash, and diarrhea.<br /><br />Further diagnostic evaluations, including a bone marrow biopsy, revealed bone marrow aplasia, aligned with drug-induced hepatopathy indications. Importantly, peripheral blood analysis showed chimerism, with a high percentage of donor T lymphocytes. This confirmed GVHD, a rare but serious complication after solid organ transplantation like the lung due to the persistence of donor lymphocytes.<br /><br />This case is exceptional given the rarity of GVHD post-lung transplant, usually more common with organs with greater lymphoid tissue. Factors contributing to this GVHD include immunosuppressant pre-conditioning and the potential underlying immune dysregulation, common in sarcoidosis.<br /><br />Treatment with increased immunosuppression using steroids and subsequent anti-thymocyte globulin initially improved the patient’s condition. However, the patient’s condition relapsed, leading to infections and eventual death from complications.<br /><br />This case underscores the importance of early diagnosis of GVHD, often initially mistaken for medication side effects or infections. The prognosis remains poor with high mortality, highlighting the need for timely and effective intervention to improve outcomes.

Keywords

graft-versus-host disease

lung transplantation

pulmonary sarcoidosis

immunosuppressants

pancytopenia

bone marrow aplasia

chimerism

donor T lymphocytes

immunosuppression

early diagnosis