HIV and immunocompromise Flashcards
A patient undergoes an allogeneic haemapoetic stem cell transplant to treat myelodysplastic syndrome. The transplant is complicated initially by fever, cough and hypoxia diagnosed as acute GvHD. They respond well to high dose intravenous methylprednisolone, recover and are then stable for 16 months. At this point they develop dry mouth and progressive breathlessness and are seen in the Respiratory clinic. Lung function has declined with a loss of 300ml of FEV1 (a fall of 18%) compared to 6 months ago. A CT scan is arranged and shows diffuse ground glass opacities with areas of confluent consolidatoin and fibrosis.
Which ONE of the following is most likely diagnosis?
A. Chronic lung GvHD
B. CMV reactivation
C. Mycobacterium Tuberculosis
D. Non-specific interstitial pneumonitis
E. Post transplant lymphoproliferative disease
A. Chronic GvHD
There are many possible pulmonary complications of stem cell transplants. The timing post transplant determines which complications are most likely. Atypical infections are always a risk given the immunosuppression, but particularly immediately post-transplant. In this case we have a fall in lung function and diffuse ground glass with areas of consolidation and fibrosis. This is an NSIP type pattern but chronic GvHD is a better explanation of the overall findings. This has occured 1-2 years post transplant. This makes chronic GvHD likely. The fact that the patient had acute GvHD initially puts them at higher risk of chronic GvHD.
