Noninfectious Pulmonary Manifestation of GVHD: Bronchiolitis Obliterans Syndrome
Pulmonary manifestations of GVHD encompass a spectrum of histologic lesions associated with both acute GVHD (aGVHD) and chronic GVHD (cGVHD). These include cryptogenic organizing pneumonia (COP), multifactorial lymphocytic bronchiolitis (LLB), and constrictive bronchiolitis obliterans (CBO). Workup of patients suspected of pulmonary cGVHD should include radiologic studies such as CT, pulmonary function tests, and bronchoalveolar lavage to rule out potential infectious agents. Lung biopsy to diagnose constrictive bronchiolitis obliterans is indicated when no other sites of involvement by cGVHD are discovered. Here we present a patient with complex pathology post-HSCT with histologic features in a lung biopsy of cryptogenic organizing pneumonia (formerly termed bronchiolitis organizing pneumonia (BOOP)) and necropsy changes of acute bronchopneumonia admixed with features of both organizing pneumonia and constrictive bronchiolitis.
KeywordsGVHD Pulmonary function tests (PFT) Bronchiolitis obliterans syndrome (BOS) Constrictive bronchiolitis obliterans (CBO) Lymphocytic bronchiolitis (LLB) Cryptogenic organizing pneumonia (COP)
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