{'fraction_non_alphanumeric': 0.037020517395182875, 'fraction_numerical': 0.015165031222123104, 'mean_word_length': 5.162087912087912, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Acute natural killer cell pneumonia in a patient transplanted with autologous haematopoietic stem cells for systemic sclerosis.

SIR, We present here a case of a 31-year-old woman referred to us for RP with migratory arthralgias, development of puffy fingers and subsequent fast, progressive centripetal skin thickening. Based on the clinical presentation and the presence of anti-topoisomerase-1 antibodies, she was diagnosed with SSc with diffuse cutaneous involvement reaching a modified Rodnan skin score of 33/ 51 despite treatment with low-dose prednisone (5 mg/day) and oral methotrexate (17.5 mg/week) followed by three pulses of i.v. cyclophosphamide (15 mg/kg, total dose 3.3 g). Although the high-resolution CT scan of the lung and a cardiac echo Doppler showed no abnormalities, the diffusing capacity of the lung for carbon monoxide (DLCO) was 4.6 mmol/kPa min (54% of the predicted value) and the bronchoalveolar lavage fluid (BALF) contained many inflammatory cells. We enrolled the patient in a clinical trial organized by the Autologous Stem cell Transplantation International Scleroderma group [1] and she was randomized into the arm of patients receiving high-dose cyclophosphamide followed by autologous haematopoietic stem cell transplantation (aHSCT) for rescue of haematopoiesis. During the first 3 months, the clinical course was uneventful. She then developed a rapidly worsening dyspnoea (upto NYHA class 3), with dry cough, fever and myalgia under CMV prophylaxis with valacyclovir 500 mg/b.i.d. Blood gas analysis demonstrated hypoxaemia and hypercapnia while breathing air. The HRCT scan of the thorax was consistent with diffuse ground-glass attenuation. Although the patient never suffered from CMV viraemia, we did detect CMV in BALF cultures (but no Mycobacterium tuberculosis, Legionella pneumophila, other Gram-positive or -negative bacteria or sequels of cytopathic viruses by microscopy). The kinetics of CMV-specific antibodies in the patient’s serum (Fig. 1A) strongly suggested that the exposure to CMV had occurred not long before the onset of the symptoms. The BALF contained high numbers of leucocytes (8.6 10 cells/ml) comprising predominantly macrophages (40%) and lymphocytes (57%), half of which