BRONCHIOLITIS OBLITERANS PRESENTING AS SUBCUTANEOUS EMPHYSEMA AND PNEUMOMEDIASTINUM - A CASE-REPORT

We describe a woman post allogeneic bone marrow transplantation (BMT), who presented to the emergency room with subcutaneous emphysema and p neumomediastinum as the first manifestation of bronchiolitis obliteran s complicating mild chronic graft versus host disease (GVHD). In contr ast to other patients with pneumomediastinum described in the literatu re, this patient suffered from only mild GVHD. She did not receive met hotrexate as GVHD prophylaxis, and the peumomediastinum was a presenti ng manifestation rather than a terminal event. In addition, this is th e first description of subcutaneous emphysema with this setting. There fore, bronchiolitis obliterans should be highly suspected in post-BMT patients presenting with pneumomediastinum and subcutaneous emphysema, and prompt therapy should be initiated.