Abstract 4671

Introduction

Infection after allo-Stem cell transplantation (SCT) is a major cause for post allo-SCT deaths. The pathogens involved are diverse and sometimes difficult to be distinguished. Treatment is primarily based on clinical history, blood analysis, chest X-ray, computerized tomography (CT) examination and pathogen culture of sputum or bronchoaleolar lavage fluid. Empirical treatment is often used before the results of pathogen culture are available. Here, we reported 2 cases of allo-SCT with similar clinical background but infections due to different pathogens.

Clinical information
Case 1Case 2
Age 15 17 
Gender female male 
Diagnosis Acute lymphatic leukemia Acute lymphatic leukemia 
Genetic result Normal karyotype Normal karyotype 
Immunological type Common B cell T Cell 
Disease state before SCT Complete remission Complete remission 
SCT type Allo- peripheral blood SCT Allo- peripheral blood SCT 
SCT donor Older sibling brother younger sibling sister 
SCT donor age 18 15 
human leucocyte antigen (HLA) matching Full match Full match 
Pretreated regimen before SCT Classic regimen busulfanum + cyclophosphaminde (Bu/Cy) Total-body irradiation (TBI) + Bu/Cy 
Neutrophil >1.0×109/L days +15 days +21 days 
Platelet >20×109/L days +19 days +23 days 
Onset of the lung disease 45 weeks after SCT 62 weeks after SCT 
Acute graft-versus-host disease (GVHD) I∼II II 
Chronic GVHD I I 
Anti-GVHD therapy Cyclosporine A (CsA) withdrawal 3 months after SCT CsA withdrawal 4 months after SCT 
Case 1Case 2
Age 15 17 
Gender female male 
Diagnosis Acute lymphatic leukemia Acute lymphatic leukemia 
Genetic result Normal karyotype Normal karyotype 
Immunological type Common B cell T Cell 
Disease state before SCT Complete remission Complete remission 
SCT type Allo- peripheral blood SCT Allo- peripheral blood SCT 
SCT donor Older sibling brother younger sibling sister 
SCT donor age 18 15 
human leucocyte antigen (HLA) matching Full match Full match 
Pretreated regimen before SCT Classic regimen busulfanum + cyclophosphaminde (Bu/Cy) Total-body irradiation (TBI) + Bu/Cy 
Neutrophil >1.0×109/L days +15 days +21 days 
Platelet >20×109/L days +19 days +23 days 
Onset of the lung disease 45 weeks after SCT 62 weeks after SCT 
Acute graft-versus-host disease (GVHD) I∼II II 
Chronic GVHD I I 
Anti-GVHD therapy Cyclosporine A (CsA) withdrawal 3 months after SCT CsA withdrawal 4 months after SCT 
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At the onset of the pulmonary diseases, anti-GVHD drugs (Including prednisone, CsA) were already withdrawn for both cases. There was no GVHD progression after withdrawal of the anti-GVHD drugs. Both cases had fever, ranging from 38 to 39 centigrade. Patients were short of breath. Oxygen inhalation was needed. Case 1 was in severe hypoxia. The oxygen saturation was down to 70%∼80% at the peak severity. Neither of the 2 cases was in need of mechanical ventilation. CT images showed that these 2 cases had similar lung injuries (Fig 1 and Fig 2). Tissue biopsy revealed that different pathogens were involved in these 2 cases, although they had identical disease history, similar duration after transplantation, same clinical symptoms and signs, even similar CT images. The histological findings of lung biopsies showed that the pathogen for case 1 was aspergillums, whereas that of case 2 was tubercle bacillus. Both cases responded well to the specific treatment, respectively. Patients are now in disease-free state.

Conclusions

Both tuberculosis and fungus infection could show diffused foci on CT image. The diffused lesions of tuberculosis tend to fuse, whereas little cavities were more frequently seen in fungus infections. After treatment, the lesions of fungus were much easier to be clear than tuberculosis. Diagnostic treatment might be used to distinguish these 2 diseases if biopsy cannot be performed or pathogen culture is negative.

Fig 1.
Fig 1. lung CT of case 1. A: when the pulmonary infection began; B: 2 weeks later; C: 4 weeks later; D: 8 weeks later.
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lung CT of case 1. A: when the pulmonary infection began; B: 2 weeks later; C: 4 weeks later; D: 8 weeks later.

Fig 1.
Fig 1. lung CT of case 1. A: when the pulmonary infection began; B: 2 weeks later; C: 4 weeks later; D: 8 weeks later.
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lung CT of case 1. A: when the pulmonary infection began; B: 2 weeks later; C: 4 weeks later; D: 8 weeks later.

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Fig 2.
Fig 2. lung CT of case 1. A: when the pulmonary infection began; B: 2 weeks later; C: 5 weeks later; D: 7 weeks later.
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lung CT of case 1. A: when the pulmonary infection began; B: 2 weeks later; C: 5 weeks later; D: 7 weeks later.

Fig 2.
Fig 2. lung CT of case 1. A: when the pulmonary infection began; B: 2 weeks later; C: 5 weeks later; D: 7 weeks later.
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lung CT of case 1. A: when the pulmonary infection began; B: 2 weeks later; C: 5 weeks later; D: 7 weeks later.

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Disclosures:

No relevant conflicts of interest to declare.

Topics:
allopurinol, fungus, lung infections, transplantation, tuberculosis, graft-versus-host disease, cyclosporine, lung ct, biopsy, acute lymphocytic leukemia

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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