Respiratory Tract Lophonomas Blattarum Infection of Allograft Hemopoietic Stem Cell Transplantation: A Case Report and Review of the Literature

Objective To explore the features of respiratory tract lophonomas blattarum infection in allograft hemopoietic stem cell transplantation.

Methods A 16 year-old male, was diagnosed of chronic myelolytic leukemia by MICM. On 2007-10-23, he underwent HLA-matched sibling donor allograft hemopoietic stem cell transplantation(Allo-HSCT). The preconditioning of transplantation is BU/CY(CCNU 250mg/m2*1d, HU40mg/Kg*2, Ara-C 2g/m2*1d, Bu 0.8mg/Kg/6h*3d, CTX 1.8g/m2*2d). CSA and MTX were used to prevent GVHD. Chest CT scan showed left inferior pneumonia on 18 days after transplantation. The patient underwent anti-bacteria, fungi and virus treatments, but his symptoms didn’t improve. Fiberoptic bronchoscopy(FOB) and bronchial alveolar lavage(BAL) was performed. It was confirmed that the pathogen was lophonomas blattarum We reported the clinical manifestation and management of respiratory tract lophonomas blattarum infection after Allo-HSCT and reviewed the clinical features of another eleven cases from the literature.

Results Infection with lophonomas blattarum mostly occurs in patients of hypoimmunity, its living conditions many in south hot and damp area. The clinical symptoms are severe and difference. Lophonomas blattarum can be observed under microscope. Metroindazole is always effctive.

Conclusion Lophonomas blattarum is a recessive infection in patients with Allo-HSCT, and co-infection of different pathogen may be involved. In Allo-HSCT patients with unexplained respiratory tract infection which do not respond to ordinary therapy, rare pathogens such as lophonomas blattarum need to be considered. Bronchoalar lavage and fiberoptic bronchoscopy examination are safe and fiberoptic bronchoscopy examination are safe and effective method in the early pathogenic diagnosis of respiratory tract infection after Allo-HSCT.