SHM Converge Scientific Abstract ePoster Gallery-Gvhd: Back With a Vengeance - Late Pulmonary Complications of Hematopoietic Stem Cell Transplant.

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A 56-year-old man, 15 years after CMV-negative hematopoietic stem cell transplant for acute lymphoblastic leukemia, presented with 3 months of progressive shortness of breath that worsened over 1 week. He had fever, bilateral crackles, leukocytosis, hyponatremia, and chest X-ray findings of bilateral opacities, so he was initially treated for atypical pneumonia with broad-spectrum antibiotics.<br /><br />His respiratory status continued to decline, and chest CT showed diffuse ground-glass opacities. Extensive infectious workup, including viral studies, fungal PCR, and Pneumocystis testing, was negative. Bronchoscopy found no infection or malignancy, but transbronchial biopsy could not be tolerated. Because late noninfectious pulmonary complications of HSCT can present similarly, the team started empiric prednisone at 1 mg/kg for presumed organizing pneumonia related to chronic graft-versus-host disease (GVHD). The patient improved symptomatically within 24 hours, and imaging showed improvement after 3 weeks of steroid therapy.<br /><br />He was later hospitalized for a pneumothorax, and VATS-assisted biopsy confirmed lung changes consistent with chronic GVHD, including organizing pneumonia and acute lung injury.<br /><br />The case highlights that late pulmonary complications after HSCT, especially cryptogenic organizing pneumonia and bronchiolitis obliterans syndrome, may occur long after transplant and can mimic infection. Diagnosis often requires exclusion of infectious causes when biopsy is not feasible, and treatment typically involves prolonged corticosteroids with gradual taper. Clinicians should maintain suspicion for GVHD-related lung disease in transplant survivors presenting with multifocal pneumonia or unexplained respiratory decline.

Asset Subtitle

Julia Solomon

Meta Tag

Author List Jacob Zinn, Julia Solomon, Mahmoud Mowafy

Category Clinical Vignettes

Concept Stem Cell Transplantation

Concept Cryptogenic Organizing Pneumonia

Concept Bronchiolitis Obliterans Syndrome

Concept Pulmonary Complication

Concept Corticosteroid

Distinguished Non-Finalist

Presenter Organization Brown University/ Lifespan

Presenting Author Julia Solomon

Track Adult

Keywords

hematopoietic stem cell transplant

chronic graft-versus-host disease

organizing pneumonia

cryptogenic organizing pneumonia

bronchiolitis obliterans syndrome

ground-glass opacities

diffuse pulmonary infiltrates

corticosteroid therapy

pneumothorax

transplant-related lung disease

Stem Cell Transplantation

Cryptogenic Organizing Pneumonia

Bronchiolitis Obliterans Syndrome

Pulmonary Complication

Corticosteroid