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Late onset graft versus host disease requiring lung transplantation following bone marrow transplant

A spectrum of clinic-pathologic pulmonary manifestations of graft versus host disease following bone marrow transplant has been reported. These manifestations are usually underdiagnosed. Lung transplantation to manage end stage lung disease following the development of this entity is extremely rare. Herein, we present the diagnosis and management of a patient who presented with severe lung disease following graft versus host disease in the setting of previous bone marrow transplant. A 29-year-old male underwent allogeneic bone marrow transplantation two years ago for recurrent acute lymphocytic leukaemia. The patient developed graft versus host disease with cutaneous, pulmonary and hepatic involvement. His pulmonary disease included interstitial pulmonary fibrosis, obliterative bronchiolitis and recurrent pneumothoraces, requiring admission to the intensive care unit for the management of adult respiratory distress syndrome. The patient underwent left sided lung transplant for the treatment of respiratory failure. Except for an episode of post-operative pneumonia, he had an uneventful recovery. The patient was discharged home in satisfactory clinical condition one month post-operatively. The features of pulmonary disease following graft versus host disease will be discussed along with a brief review of the relevant literature.