Diffuse Pulmonary Nodular Infiltrates in a Renal Transplant Recipient
2001; Elsevier BV; Volume: 120; Issue: 4 Linguagem: Inglês
10.1378/chest.120.4.1394
ISSN1931-3543
AutoresElke Ullmer, Heinz Borer, P Sandoz, Michael Mayr, Peter Dalquen, Markus Solèr,
Tópico(s)Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
ResumoA 48-year-old man with end-stage renal disease due to bilateral hydronephrosis had undergone a cadaveric kidney transplantation in April 1990, after 3 years of hemodialysis. His maintenance immunotherapy consisted of cyclosporine, 150 mg/d; prednisolone, 7.5 mg/d; and azathioprine, 125 mg/d. In August 1999, cyclosporine-associated arteriopathy and chronic rejection led to progressive graft failure, and he was evaluated for retransplantation. Unexpectedly, the chest radiograph revealed bilateral confluent alveolar opacities, with a nodular, fluffy appearance observed on high-resolution CT (Fig 1, 2). The patient denied fever, cough, weight loss, night sweats, or dyspnea. Results of pulmonary function testing and arterial blood gas analysis were normal; only a metabolic acidosis was noticed. Physical examination detected hypertension (BP, 184/97 mm Hg), obesity (body mass index, 30), a grade 2/6 aortic ejection murmur, and edema of the legs. Results of chest and abdominal examination were normal. Lymph nodes were not enlarged, and no skin lesions could be seen. Figure 2High-resolution CT scan of the chest shows diffuse, fluffy, and confluent dense alveolar infiltration. The higher sensitivity of high-resolution CT in comparison to radiography reveals the extent of the nodular opacities. View Large Image Figure Viewer
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