Abstract
A two-year-old boy with severe aplastic anemia underwent successfully the second marrow grafting from his HLA-identical sister after the rejection of the first graft from the same HLA-identical donor. A skin rash and conjunctivitis developed as acute GVHD. Following the tapering off of oral prednisolone for chronic GVHD by day 538, he developed recurrent cough on exertion. Bronchodilators and antibiotics were administered without improvement. Pulmonary ventilation scans showed abnormal areas of decreased activity, corresponding to similar areas of decreased activity on perfusion scans. Dryness of the eyes and chronic infection of lacrimal sacs due to the obstruction of the nasolacrimal ducts were also noted. Oral prednisone following intravenous methylprednisolone was begun with clinical improvement. Although air-trapping remained on lung volume studies, with enlarged residual volume and reduced forced expiratory volume, quality of life of the patient markedly improved following the oral prednisone. It is suggested that prompt clinical diagnosis and administration of immunosuppressive drugs might be very important for the treatment of the pulmonary manifestation of chronic GVHD.
