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Acute Respiratory Failure: A Rare Presentation of a Well-Known Chronic Disease in Lung Transplantation
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A6573 - Acute Respiratory Failure: A Rare Presentation of a Well-Known Chronic Disease in Lung Transplantation
Author Block: T. Thaniyavarn1, D. C. Neujahr2; 1Pulmonary and Critical Care Medicine, Duke University Hospital, Durham, NC, United States, 2Pulmonary and Critical Care Medicine, Emory, Atlanta, GA, United States.
Introduction: Chronic rejection especially bronchiolitis obliterans syndrome (BOS) is a major barrier for lung allograft survival. Most cases typically run a chronic course as the name implies. However, like many other common diseases, a rare presentation does occur. Here we present a case of BOS that manifests as acute respiratory failure. Case Presentation: A 40-year-old white male who was 2 years post bilateral lung transplantation for cystic fibrosis presented to us with acute onset of dyspnea with substernal chest pain while playing golf. The patient was in his usual health prior to this. He exercises daily without any limitation. He denies fever, cough, and sick contact. A detailed history was unable to identify any unusual exposure. He maintained good blood pressure but was tachycardic and hypoxemic with an O2 saturation of 93% on room air. Pulmonary embolism (PE) was a concern and he was started on heparin drip. However, subsequent imaging did not show any PE or any abnormal lung parenchyma. electrocardiogram, cardiac enzyme, and echocardiogram with contrast were normal. Bronchoalveolar lavage and transbronchial lung biopsy were non-diagnostic. There was no evidence of acute rejection or infection. A lung function test showed severe airflow limitation. Expiratory-Inspiratory CT chest showed evidence of air trapping. A diagnosis of BOS was made. Despite high dose steroid, increasing immunosuppressant, and anti-thymocyte globulin, the patient ultimately expired 2 months later before re-transplant could take place. Conclusion: Our case demonstrates that BOS can present as an acute respiratory failure in a relatively healthy lung transplant patient. The progression is rapid and re-listing for urgent transplantation once the diagnosis is made may be the only treatment.
Author Block: T. Thaniyavarn1, D. C. Neujahr2; 1Pulmonary and Critical Care Medicine, Duke University Hospital, Durham, NC, United States, 2Pulmonary and Critical Care Medicine, Emory, Atlanta, GA, United States.
Introduction: Chronic rejection especially bronchiolitis obliterans syndrome (BOS) is a major barrier for lung allograft survival. Most cases typically run a chronic course as the name implies. However, like many other common diseases, a rare presentation does occur. Here we present a case of BOS that manifests as acute respiratory failure. Case Presentation: A 40-year-old white male who was 2 years post bilateral lung transplantation for cystic fibrosis presented to us with acute onset of dyspnea with substernal chest pain while playing golf. The patient was in his usual health prior to this. He exercises daily without any limitation. He denies fever, cough, and sick contact. A detailed history was unable to identify any unusual exposure. He maintained good blood pressure but was tachycardic and hypoxemic with an O2 saturation of 93% on room air. Pulmonary embolism (PE) was a concern and he was started on heparin drip. However, subsequent imaging did not show any PE or any abnormal lung parenchyma. electrocardiogram, cardiac enzyme, and echocardiogram with contrast were normal. Bronchoalveolar lavage and transbronchial lung biopsy were non-diagnostic. There was no evidence of acute rejection or infection. A lung function test showed severe airflow limitation. Expiratory-Inspiratory CT chest showed evidence of air trapping. A diagnosis of BOS was made. Despite high dose steroid, increasing immunosuppressant, and anti-thymocyte globulin, the patient ultimately expired 2 months later before re-transplant could take place. Conclusion: Our case demonstrates that BOS can present as an acute respiratory failure in a relatively healthy lung transplant patient. The progression is rapid and re-listing for urgent transplantation once the diagnosis is made may be the only treatment.
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