Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

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

Azithromycin 투여로 폐기능이 호전된 폐쇄성 세기관지염 1예

  • Oh, Ji Hye (Department of Internal Medicine. Catholic University of Daegu School of Medicine) ;
  • Kim, Kyung Chan (Department of Internal Medicine. Catholic University of Daegu School of Medicine) ;
  • Kim, Sung Woo (Department of Internal Medicine. Catholic University of Daegu School of Medicine) ;
  • Hyun, Dae Sung (Department of Internal Medicine. Catholic University of Daegu School of Medicine) ;
  • Lee, Sang Chae (Department of Internal Medicine. Catholic University of Daegu School of Medicine) ;
  • Bae, Sung Hwa (Department of Internal Medicine. Catholic University of Daegu School of Medicine) ;
  • Jung, Kyung Jae (Department of Radiology, Catholic University of Daegu School of Medicine) ;
  • Kwon, Kun Young (Department of Pathology, Keimyung University School of Medicine)
  • 오지혜 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 김경찬 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 김성우 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 현대성 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 이상채 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 배성화 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 정경재 (대구가톨릭대학교 의과대학 진단영상의학교실) ;
  • 권건영 (계명대학교 의과대학 병리학교실)
  • Received : 2008.07.27
  • Accepted : 2008.09.16
  • Published : 2008.11.30
Download PDF
⟨ Previous Next ⟩

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 ($FEV_1$) 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.

폐쇄성 세기관지염은 골수 이식 후 폐에 발생하는 합병증이다. 현재 스테로이드와 면역 억제제를 투여하여 적극적인 치료를 하더라도 폐기능의 호전을 보이는 경우는 일부에 불과하다. 저자들은 기존의 치료에도 불구하고 호전을 보이지 않은 골수 이식 후 발생한 폐쇄성 세기관지염 환자에서 macrolide계 항생제인 azithromycin을 1년간 경구 투여하여 폐기능이 호전됨을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Roca J, Granena A, Rodriguez-Roisin R, Alvarez P, Agusti-Vidal A, Rozman C. Fatal airway disease in an adult with chronic graft-versus-host disease. Thorax 1982;37:77-8. https://doi.org/10.1136/thx.37.1.77
  2. Soubani AO, Uberti JP. Bronchiolitis obliterans following haematopoietic stem cell transplantation. Eur Respir J 2007;29:1007-19. https://doi.org/10.1183/09031936.00052806
  3. Marras TK, Chan CK. Obliterative bronchiolitis complicating bone marrow transplantation. Semin Respir Crit Care Med 2003;24:531-42. https://doi.org/10.1055/s-2004-815602
  4. Khalid M, Al Saghir A, Saleemi S, Al Dammas S, Zeitouni M, Al Mobeireek A, et al. Azithromycin in bronchiolitis obliterans complicating bone marrow transplantation: a preliminary study. Eur Respir J 2005;25:490-3. https://doi.org/10.1183/09031936.05.00020804
  5. Katzenstein AL. Chap 16. Miscellaneous II. Nonspecific inflammatory and destructive diseases. In: Katzenstein AL, editor. Surgical pathology of non-neoplastic lung disease. 4th ed. Philadelphia: Saunders; 2006. p. 457-64.
  6. Kim CJ, Kook H, Cho SH, Choi SH, Hwang MJ, Hwang TJ. Bronchiolitis obliterans and generalized vitiligo as rare presentations of chronic graft-versus-host disease. Korean J Pediatr Hematol-Oncol 1998;5:207-15.
  7. Afessa B, Litzow MR, Tefferi A. Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation. Bone Marrow Transplant 2001;28:425-34. https://doi.org/10.1038/sj.bmt.1703142
  8. Corrin B, Nicholson AG. Chapter 3. Diseases of the airways. In: Corrin B, Nicholson AG, editors. Pathophysiology of the lungs. 2nd ed. Philadelphia: Churchill Livingstone; 2006. p. 119-22.
  9. Sakaida E, Nakaseko C, Harima A, Yokota A, Cho R, Saito Y, et al. Late-onset noninfectious pulmonary complications after allogeneic stem cell transplantation are significantly associated with chronic graft-versus-host disease and with the graft-versus-leukemia effect. Blood 2003;102:4236-42. https://doi.org/10.1182/blood-2002-10-3289
  10. Au WY, Ho JC, Lie AK, Sun J, Zheng L, Liang R, et al. Respiratory ciliary function in bone marrow recipients. Bone Marrow Transplant 2001;27:1147-51. https://doi.org/10.1038/sj.bmt.1703049
  11. Ringden O, Remberger M, Ruutu T, Nikoskelainen J, Volin L, Vindelov L, et al. Increased risk of chronic graft-versus- host disease, obstructive bronchiolitis, and alopecia with busulfan versus total body irradiation: long-term results of a randomized trial in allogeneic marrow recipients with leukemia. Blood 1999;93:2196-201.
  12. Gerhardt SG, McDyer JF, Girgis RE, Conte JV, Yang SC, Orens JB. Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study. Am J Respir Crit Care Med 2003;168:121-5. https://doi.org/10.1164/rccm.200212-1424BC
  13. Bashoura L, Gupta S, Jain A, Couriel DR, Komanduri KV, Eapen GA, et al. Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation. Bone Marrow Transplant 2008;41:63-7. https://doi.org/10.1038/sj.bmt.1705877
  14. Tamaoki J. The effects of macrolides on inflammatory cells. Chest 2004;125:41S-50S. https://doi.org/10.1378/chest.125.2_suppl.41S