Bronchiolitis obliterans organizing pneumonia associated with Pneumocystis carinii infection in a liver transplant patient receiving tacrolimus

Abstract

We report on a case of bronchiolitis obliterans organizing pneumonia (BOOP) associated with Pneumocystis carinii pneumonia (PCP) after liver transplantation and tacrolimus based immunosuppression. Radiologically, bilateral diffuse interstitial shadowing and patchy alveolar infiltrates developed after switching the patient from cyclosporin A to tacrolimus for persistent rejection. Bronchoalveolar lavage (BAL) fluid showed inflammatory cells but no pathogenic organisms. Open lung biopsy revealed BOOP with granulomatous PCP. Thus, even in the case of negative BAL the possibility of an atypical P. carinii infection has to be considered for differential diagnosis of pneumonia in immunocompromised patients after organ transplantation. The combination of BOOP with PCP after liver transplantation and tacrolimus medication has not been reported previously.

Organizing Pneumonia as a Manifestation of Pneumocystis jiroveci Immune Reconstitution Syndrome in HIV-positive Patients

“…6,7,[11][12][13][14] The association of PCP and OP has also been reported in a lung transplant recipient, 15 in a renal transplant patient on sirolimus, 16 and in a liver transplant patient receiving tacrolimus. 17 Our 2 cases differ from those described previously because they occurred in the context of immune reconstitution after HAART introduction.…”

Bacterial, mycobacterial, and protozoal infections after liver transplantation—Part I

“…Pneumonia can be difficult to diagnose, and telescoping catheter cultures,41 bronchoalveolar lavage,40–45 and biopsies41, 43 can help identify the infectious agent. In addition, these tests can determine if the patient has a noninfectious pneumonia‐mimicking illness such as bronchiolitis obliterans with organizing pneumonia 46–49…”

Cryptogenic organising pneumonia

“…Cryptococcus neoformans [219] Penicillium janthinellum [220] Pneumocystis jiroveci In patients with HIV infection [207,221,222]; in a lung transplant recipient [200]; in a liver transplant patient [223]; following highly active antiretroviral therapy introduction [211] COP. Patients receiving radiation therapy to the breast develop bilateral alveolar lymphocytosis of similar intensity in both lungs within 15 days after completion of radiotherapy, regardless of whether the patients later develop pneumonitis or not [303][304][305].…”