Acute fibrinous and organizing pneumonia after bone marrow transplantation, an underrecognized, severe condition

Allogeneic bone marrow transplantation can lead to various pulmonary complications, including acute fibrinous organizing pneumonia. This condition is rare and presents with aggressive clinical features, distinct from other forms of organizing pneumonia, such as cryptogenic organizing pneumonia.

A literature review using the PubMed, Embase, Lilacs, and Cochrane databases was conducted to analyze cases of acute fibrinous organizing pneumonia following transplantation focusing on clinical features, therapeutic approaches, and outcomes.

The case of a 62-year-old female who developed acute fibrinous organizing pneumonia after transplantation for acute myeloid leukemia is presented. Despite an initial absence of infectious agents, parainfluenza virus was later identified in a bronchoalveolar lavage. The patient progressed to severe hypoxemic respiratory failure and was unresponsive to corticosteroids and rituximab, ultimately dying seven months post-transplant.

This is a rare and severe complication following allogeneic bone marrow transplantation. Early diagnosis, histopathological confirmation, and prompt initiation of corticosteroid therapy are critical for improving outcomes. Patients diagnosed before Day +100 generally have a better response to treatment and more favorable clinical outcomes. The need for a more effective and targeted treatment strategy remains an unmet challenge in managing this condition.