A 22-year-old male received a bilateral lung transplant for cystic fibrosis and had an essentially uncomplicated post-transplantation course for 26 months (with the exception of a Grade A2 rejection episode at 12.5 months post-transplant). He developed worsening cough, increasing fatigue, and dyspnoea following exposure to his spouse who had developed upper respiratory tract infection symptoms. Spirometry showed a significant decline in FEV1, and oxyhaemoglobin desaturation was noted. TBB revealed changes of AFOP and was also graded as showing a Grade A1B1 acute rejection, and BAL cultured MSSA at 2 x 104 colony forming units (cfu)/microl but was negative for respiratory viruses. The patient's symptoms initially improved with antibiotics and pulse methylprednisolone, but FEV1 subsequently progressively declined and the patient eventually succumbed to respiratory insufficiency.
acute fibrinous and organising pneumonia, interstitial, lung transplantation, pneumonia, thoracic