CHRONIC EOSINOPHILIC PNEUMONIA IN A PATIE NT TREATED WITH ALLOGENIC BONE-MARROW TRANSPLANTATION

A 39 year old patient diagnosed of severe aplastic anemia and treated with allogenic bone marrow transplantation and who presented chronic e osinophilic pneumonia eight months after the transplant is presented. The patient had no previous history of asthma or atopy. Conditioning w as performed with cyclophosphamide and total body irradiation. Prophyl axis of the graft versus host disease was carried out with cyclosporin and short course of methotrexate. At day 30 mild graft venus host dis ease appeared which spontaneously resolved. A progressive increase in the number of eosinophils was observed from day +40 reaching 1,05 x 10 (9)/I at day +180 coinciding with suspension of the ciclosporine. The patient remained asymptomatic with no evidence of chronic graft versus host disease. At 8 months following allogenic transplantation the pat ient developed three episodes of fever, cough, moderate dyspnea and pu lmonary infiltrates. Respiratory tests showed a restrictive pattern. B ronchoalveolar lavage contained 20 % of eosinophils. Upon lung biopsy alveolar infiltration by eosinophils, lymphocytes and mononuclear cell s was observed. Diagnosis of chronic eosinophilic pneumonia was made w ith initiation of steroid treatment. A drastic response was observed. The patient remained asymptomatic without recurrence and without evide nce of chronic graft versus host disease. This picture may have been c aused by the donor eosinophils given that retrospective evaluation dem onstrated a persistent moderate eosinophilia in the donor.