[Early-onset antibody-mediated rejection with fever as the main manifestation after bilateral lung transplantation: a...

Antibody-mediated rejection (AMR) is a recognized cause of allograft dysfunction in lung transplant recipients due to the presence of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs). Here, we reported that a 69-year-old woman with underlying connective tissue disease-associated interstitial lung disease (CTD-ILD) developed recurrent fever with elevated white blood cells, C-reactive protein (CRP) and new ground-glass opacities on chest computed tomography (CT) early after double lung transplantation. After a thorough investigation for infection, rejection and relapse of primary immune diseases, the patient was found to be panel-reactive antibody (PRA) positive and DSAs positive. Pathology of the transbronchial lung biopsy (TBLB) revealed positive histology suggestive of AMR and positive C4d staining. The final diagnosis was definite clinical AMR. Following treatment with plasma exchange and intravenous immunoglobulin (IVIg) infusion, the patient's condition improved significantly, and the patient was discharged from hospital.