A 48-year-old female received a heart-lung transplant for congenital heart disease. Early sputum cultures demonstrated Gram-negative rods for which piperacillin-tazobactam was given, and she was extubated on the second day, post-transplant, and commenced ambulation. However, small bowel complications developed and required surgical resection, and she developed dialysis-dependent acute renal insufficiency. Intubation and mechanical ventilation were required on day 30, and chest imaging showed persistent diffuse infiltrates (Figure 1, A and B). TBB showed minimal acute rejection (Grade A1B0). She was extubated 9 days later but required reintubation (post-transplant day 58) for progressive respiratory failure. TBB biopsy showed AFOP but did not show acute rejection (Figure 2, A and B), and an endomyocardial biopsy was negative for cardiac rejection. A laparotomy and right hemicolectomy were performed for persistent volvulus (post-transplant day 100). Lung function worsened, and Citrobacter freundii was isolated from blood cultures, BAL, and urine cultures. Respiratory status progressively worsened, and life support was withdrawn.
acute fibrinous and organising pneumonia, interstitial, lung transplantation, pneumonia, thoracic