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Case Reports in Hematology
Volume 2012, Article ID 957612, 3 pages
http://dx.doi.org/10.1155/2012/957612
Case Report

Early Pathologic Findings of Bronchiolitis Obliterans after Allogeneic Hematopoietic Stem Cell Transplantation: A Proposal from a Case

1Department of Hematology, Faculty of Medicine and Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenoudai Tsukuba, Ibaraki 305-8575, Japan
2Department of Pathology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenoudai Tsukuba, Ibaraki 305-8575, Japan
3Department of Pathology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura, Nagoya 453-8511, Japan

Received 26 June 2012; Accepted 19 July 2012

Academic Editors: N. Hamerschlak, K. Konstantopoulos, and R. Tiu

Copyright © 2012 Rie Nakamoto-Matsubara et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bronchiolitis obliterans (BO) is one of the serious, noninfectious pulmonary complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Early diagnosis of BO is usually difficult because patients are often asymptomatic at an initial stage of the disease and pathologic findings are available mostly at the late stages. Therefore, the diagnosis of the disease is based on the pulmonary function test using the National Institute of Health consensus criteria. Here, we report a case of slowly progressive BO. A biopsy specimen at an early stage demonstrated alveolar destruction with lymphocyte infiltration in bronchial walls and mild narrowing of bronchioles without fibrosis, those were strongly indicative of initial pathologic changes of BO. Definitive BO followed, which was proven by both clinical course and autopsy. While alloreactive lymphocytes associated with chronic graft-versus-host disease are believed to initiate BO, we present a rare case that directly implies such a scenario.