GIANT-CELL INTERSTITIAL PNEUMONITIS - DISEASE RECURRENCE IN THE TRANSPLANTED LUNG

Recurrence of the original disease in the transplanted organ is well r eported in renal transplant recipients. There have been no previously fully documented cases of recurrence of the original disease after lun g transplantation. We report a patient who underwent single-lung trans plant in 1990 for end-stage respiratory failure secondary to biopsy-pr oved giant cell interstitial pneumonitis (GIP). There was no further i ndustrial exposure. Surveillance bronchoscopies and biopsies post-tran splant demonstrated eosinophils and giant cells in the bronchoalveolar ravage of both lungs, and in biopsies of the transplanted organ. Two years after successful transplantation the patient deteriorated and un derwent open lung biopsy, which demonstrated not only bronchiolitis ob literans but also the classic features of GIP. There was no evidence o f inorganic particles in the transplanted lung. Autopsy confirmed the presence of numerous giant cells characteristic of GIP with associated fibrosis throughout the transplanted lung. Although tungsten and othe r inorganic particles were again demonstrated in the native lung, ther e was no evidence of tungsten particles in the transplanted lung. We b elieve that this case documents recurrence of the original disease aft er lung transplantation. The absence of unusual inorganic particles in the transplanted lung in the face of the classic picture of GIP is hi ghly suggestive of an autoimmune mechanism for this occupation-associa ted disease. The appropriateness of transplant in the management of th is lung disease should be reviewed further.