Case 260: Endobronchial Posttransplantation Lymphoproliferative Disease

Area of Science:

• Pulmonary Medicine
• Transplantation Immunology
• Diagnostic Imaging

Background:

• A 31-year-old woman, 10 months post-bilateral orthotopic lung transplantation for cystic fibrosis, presented with a new-onset cough.
• She reported increased sinus congestion and a chest sensation, with no signs of active infection on bronchoscopy.

Observation:

• Physical exam revealed borderline tachycardia and mild hypertension; oxygen saturation was 96% on room air.
• Pulmonary function tests showed a decreased forced expiratory volume in 1 second to forced vital capacity ratio (64%), indicating an obstructive process.
• Sputum cultures from one month prior grew Pseudomonas and methicillin-resistant Staphylococcus aureus, considered colonization.

Findings:

• Chest radiography, CT, and 18F-FDG PET/CT were performed to evaluate the obstructive lung process.
• Imaging findings are detailed in accompanying figures (Figs 1-4).

Implications:

• This case highlights the diagnostic approach to new respiratory symptoms in lung transplant recipients.
• Understanding imaging findings is crucial for differentiating colonization from active infection and guiding management in this vulnerable population.