PMC8606675_01
(A) Chest x-ray obtained Day +42 demonstrates diffuse airspace disease bilaterally with more focal areas of consolidation in the left lung. (B, C) Thin-section computed tomography (CT) obtained Day +49 (from 2nd transplant) demonstrate diffuse ground-glass opacification involving all 5 lobes.
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f1
On Day +37 she was readmitted with tachypnea, a new oxygen requirement, and a diffuse bilateral airspace disease on chest x-ray (Figure 1A). CT scan showed diffuse ground glass appearance with air trapping in the lower lobes (Figures 1B, C).
Pulmonary wedge biopsy, Day +55. (A) Patchy consolidation, 2x. (B) Organizing pneumonia with fibroblastic proliferation in terminal airways and numerous macrophages occupying airspaces, 10x. (C) Pulmonary arterial thrombus with alternating bands of fibrin and platelets (lines of Zahn), 4x. (A-C). Hematoxylin and eosin stain, magnifications using Leica Biosystems Aperio ImageScope.
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f2
Her lung biopsy demonstrated organizing pneumonia with patchy consolidation (Figure 2A), characterized by prominent fibroblastic proliferation in terminal airways and numerous macrophages occupying airspaces, compatible with cryptogenic organizing pneumonia (COP) (Figure 2B). An occlusive arterial thrombus was noted (Figure 2C), a possible sequela of TMA.
Timeline of events for ICU admission.
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f3
Her clinical course is summarized in Figure 3.