Exploring the possibilities: airspace disease in the postallogeneic haematopoietic stem cell transplant period

A 50-year-old man with a history of myelodysplastic syndrome status postallogeneic haematopoietic stem cell transplantation (HSCT) in July 2013 presented in January 2014 with a 6-week history of worsening shortness of breath and dry cough. Chest imaging revealed scattered groundglass opacities in the upper lobes bilaterally and two areas of focal consolidation on the left side. Bronchoscopy with bronchoalveolar lavage grew methicillin-resistant Staphylococcus aureus and the patient was treated with a prolonged course of vancomycin without improvement in symptoms or oxygenation. Image-guided core biopsy of an area of consolidation revealed histological findings of acute fibrinous and organising pneumonia. The patient was diagnosed with what appeared to be a manifestation of chronic graft-versus-host disease of the lung and started on high-dose corticosteroids with resultant improvement in symptoms. The response was short-lived and the patient expired 2 months later.