- Letters to the Editor
- Open access
- Published:
Thoracic air leak syndrome as the sole manifestation of chronic lung graft-versus-host disease: a case report
The Egyptian Journal of Bronchology volume 17, Article number: 5 (2023)
I read with great interest the article published in the journal by Nair et al., titled Thoracic air leak syndrome as the sole manifestation of chronic lung graft-versus-host disease: a case report [1]. The case report was an elaborate narrative of the management of respiratory symptoms and syndromes encountered in a post-stem cell transplant recipient spanning more than 200 days. I would like to offer the following comment about the case report.
-
a.
The authors have mentioned that there was no clinical, physiological, and radiological evidence of lung graft-versus-host disease (GVHD). But the patient’s pulmonary function test showed obstructive ventilatory defect which leads to considering bronchiolitis obliterans syndrome (BOS) in the patient. Beschorner et al. first described the syndrome manifesting as a new onset airflow obstruction following hematopoietic stem cell transplantation (HSCT) [2]. Here, in this patient, it would be of significant importance to know the baseline pulmonary function test pre-HSCT.
-
b.
The index patient has no lung parenchymal changes in the illustrated computed tomography images, but expiratory imaging was not done. The expiratory scan is more sensitive for diagnosing air trapping which is a consistent finding in BOS, and also, bronchiolitis obliterans has been mentioned as one of the indications of doing expiratory imaging when there is a normal inspiratory imaging [3].
-
c.
The National Institute of Health (NIH) criteria for the diagnosis of BOS, in a patient already having GVHD manifestation in other organs, take into account only pulmonary function test (PFT) parameters and absence of infections [4]. Knowing the details of the index patient’s PFT like forced expiratory volume in 1 s (FEV1), FEV1-to-vital capacity ratio, and lung volumes would be essential before ruling out the possibility of BOS. Radiological evidence of air trapping is no longer an essential criterion in the updated diagnostic criteria, as this may be absent in the early phase of the disease [5].
Availability of data and materials
Not applicable.
Abbreviations
- GVHD:
-
Graft-versus-host disease
- BOS:
-
Bronchiolitis obliterans syndrome
- HSCT:
-
Hematopoietic stem cell transplantation
- NIH:
-
National Institute of Health
- PFT:
-
Pulmonary function test
- FEV1:
-
Forced expiratory volume in 1 s
References
Nair AA, Raja A, Devasia AJ et al (2022) Thoracic air leak syndrome as the sole manifestation of chronic lung graft-versus-host disease: a case report. Egypt J Bronchol 16:60. https://doi.org/10.1186/s43168-022-00163-5
Beschorner WE, Saral R, Hutchins GM, Tutschka PJ, Santos GW (1978) Lymphocytic bronchitis associated with graft-versus-host disease in recipients of bone-marrow transplants. New Engl J Med 299(19):1030–1036
Gaeta M, Minutoli F, Girbino G, Murabito A, Benedetto C, Contiguglia R, Ruggeri P, Privitera S (2013) Expiratory CT scan in patients with normal inspiratory CT scan: a finding of obliterative bronchiolitis and other causes of bronchiolar obstruction. Multidiscip Respir Med 8(1):44. https://doi.org/10.1186/2049-6958-8-44 PMID: 23835554; PMCID: PMC3710098
Jagasia MH, Greinix HT, Arora M et al (2015) National Institutes of Health Consensus Development Project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant 21(3):389–401
Williams KM (2016) How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Blood 129(4):448–455. https://doi.org/10.1182/blood-2016-08-693507
Acknowledgements
Nil.
Funding
Nil.
Author information
Authors and Affiliations
Contributions
VG is involved in the conceptualization, manuscript writing, and editing. The author(s) read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
Nil.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Govindasaami, V. Thoracic air leak syndrome as the sole manifestation of chronic lung graft-versus-host disease: a case report. Egypt J Bronchol 17, 5 (2023). https://doi.org/10.1186/s43168-023-00180-y
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s43168-023-00180-y