Tuberc Respir Dis.  2008 Nov;65(5):410-415.

Improvement of Pulmonary Function after Administration of Azithromycin in a Patient with Bronchiolitis Obliterans: a Case Report

• Oh JH
• Kim KC
• Kim SW
• Hyun DS
• Lee SC
• Bae SH
• Jung KJ
• Kwon KY

Abstract

Bronchiolitis obliterans (BO) is a serious noninfectious complication following an allogeneic bone marrow transplant (BMT). A 21-year-old female received an allogeneic BMT as a treatment for myelodyplastic syndrome. Four months after the BMT, progressive dyspnea developed and BO was also diagnosed by a lung biopsy. The patient was administered steroid and immunosuppressive agents for 1 year but there was no improvement in pulmonary function. Azithromycin was prescribed (500 mg q.d. for 3 days followed by 250 mg three time a week) because macrolides might decrease the inflammatory reaction leading to BO. The patient's pulmonary function improved after administration of azithromycin for 1 year. The forced expiratory volume in a one second (FEV1) increase was 220 mL (28.2%) and the forced vital capacity (FVC) increase was 460 mL (25.7%). We report the improvement in the pulmonary function after the administration of azithromycin for 1 year in a patient with BO after a BMT.

Keyword

Bone marrow transplantation; Bronchiolitis obliterans; Pulmonary function; Azithromycin

MeSH Terms

Azithromycin
Biopsy
Bone Marrow
Bone Marrow Transplantation
Bronchiolitis
Bronchiolitis Obliterans
Dyspnea
Female
Forced Expiratory Volume
Humans
Immunosuppressive Agents
Lung
Macrolides
Transplants
Vital Capacity
Young Adult
Azithromycin
Immunosuppressive Agents
Macrolides

Figure

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  Figure 1 PA view shows no parenchymal abnormality in both lungs. PA: pulmonary artery.

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  Figure 2 Chest HRCT image at the level of inferior pulmonary vein shows subtle hyperlucency of right middle and both lower lobes, which was more evident on images taken during expiration (not shown) (A) and bronchial dilation (long arrow) and circumferential bronchial wall thickening (short arrow) are seen at the level of left ventricle (B).

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  Figure 3 (A) The bronchiole shows markedly fibro-inflammatory thickening of the wall (long arrow) and prominent narrowing of the lumen. The adjacent lung parenchyma shows focal emphysematous change with rupture of the alveolar walls (short arrows) (H&E stain, ×40). (B) The constricted bronchiole shows markedly proliferated smooth muscle bundles (long arrows) and slit-like narrowed lumen with loss of the bronchiolar epithelium (short arrow) (H&E stain, ×100).

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