The 513th case: acute respiratory failure after bilateral lung transplantation
10.3760/cma.j.cn112138-20250702-00384
- VernacularTitle:第513例——双肺移植术后急性呼吸衰竭
- Author:
Shiwei QUMU
1
;
Bei WANG
;
Min LIU
;
Min LI
;
Guowu ZHOU
;
Wenhui CHEN
Author Information
1. 中日友好医院呼吸与危重症医学科 中日友好医院呼吸中心 国家呼吸医学中心 呼吸与共病全国重点实验室 国家呼吸疾病临床研究中心 中国医学科学院呼吸病学研究院，北京 100029
- Publication Type:Journal Article
- Keywords:
Lung transplantation;
Organizing pneumonia;
Extracorporeal membrane oxygenation;
Transbronchial cryobiopsy;
Chronic lung allograft dysfunction
- From:
Chinese Journal of Internal Medicine
2025;64(11):1140-1144
- CountryChina
- Language:Chinese
-
Abstract:
A 67-year-old male had undergone bilateral lung transplantation for chronic obstructive pulmonary disease 11 months before the current presentation. He was admitted with a 5-day history of cough with sputum, and a 2-day history of fever. Computed tomography (CT) of the chest revealed rapidly progressive bilateral diffuse "ground glass" opacities. Despite anti-infective therapy and methylprednisolone pulse therapy, his condition deteriorated, necessitating endotracheal intubation with mechanical ventilation and veno-venous extracorporeal membrane oxygenation (V-V ECMO) for life support. A bedside cryobiopsy was undertaken, with pathology confirming the organizing pneumonia diagnosis. Comprehensive treatment was continued: methylprednisolone, tacrolimus for immunosuppression, and prophylactic anti-infectives. His partial pressure of oxygen in the blood by the fraction of inspired oxygen ratio and imaging findings improved gradually. ECMO support was discontinued after 2 weeks, and he was discharged 1-month later, resuming normal daily activities. At 2-month follow-up, he exhibited improved exercise tolerance. Chest CT showed bilateral upper-lobe emphysema (predominantly upper-lobe reticular shadows) and significant bilateral upper-lobe pleural thickening. After 12 months of fllow-up, a diagnosis of chronic lung allograft dysfunction was made based on imaging findings and the trajectory of pulmonary function.
