Related Experiment Video
Updated: Feb 8, 2026

Author Spotlight: Advancing Lung Transplant Immunology Through Intravital Imaging
Published on: April 19, 2024
Beyond the Lungs: Antibody-Mediated Rejection Presenting as Neuropsychiatric Syndrome After Lung Transplant: A Case
Sarah Riedi1, Dielle Crasta2, Naureen Narula3
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Kentucky, Lexington, Kentucky.
Background:
Antibody-mediated rejection (AMR) after lung transplantation is defined by allograft dysfunction, detection of donor-specific antibodies (DSAs), and exclusion of alternate etiologies. Extra-pulmonary manifestations are exceptionally uncommon.
Case Presentation:
We report a 47-year-old man, status post bilateral lung transplant for coal workers' pneumoconiosis, who presented with progressive hypoxemia, tremors, right-sided weakness, dysarthria, headaches, and personality changes over 2 months. Comprehensive neurologic, infectious, and oncologic evaluations-including magnetic resonance imaging (MRI) of the brain, cervical and thoracic spine; lumbar puncture; and positron emission tomography-computed tomography (PET-CT)-were unrevealing. Chest computed tomography (CT) demonstrated subtle interlobular thickening and ground-glass opacities, and spirometry revealed a 6.8% decline in forced expiratory volume in 1 second (FEV₁). DSA testing showed elevated DQA05:01 (mean fluorescence intensity [MFI] 25,239), DR17 (7582), and DRw52 (4635). After exclusion of infection and structural neurologic causes, AMR was diagnosed. Treatment with plasmapheresis, intravenous immunoglobulin, rituximab, and corticosteroids resulted in complete resolution of neurologic and psychiatric symptoms after the second cycle, concurrent with reduction in DSA levels (DQA05:01 16,322; DR17 3000; DRw52 undetectable). The patient completed 5 treatment cycles.
Conclusion:
This case broadens the clinical spectrum of AMR to include reversible neuropsychiatric manifestations likely mediated by systemic alloimmune inflammation. Prompt recognition and timely antibody-directed therapy can prevent misdiagnosis, preserve graft integrity, and improve outcomes in lung transplant recipients.
Related Concept Videos
Lung Capacity
Pleura of the Lungs
Gross Anatomy of the Lungs
Antibody Structure
Antibodies, also known as immunoglobulins (Ig), are essential players of the adaptive immune system. These antigen-binding proteins are produced by B cells and make up 20 percent of the total blood plasma by weight. In mammals, antibodies fall into five different classes, which each elicits a different biological response upon antigen binding.
The Y-Shaped Structure of Antibodies Consists of Four Polypeptide Chains
Antibodies consist of four polypeptide chains: two identical heavy...
Hypothesis: Accept or Fail to Reject?
There are two ways to indicate that the null hypothesis is not rejected. 'Accept' the null...
Quantifying and Rejecting Outliers: The Grubbs Test

