A severe Mycoplasma pneumoniae pneumonia inducing an acute antibody-mediated pulmonary graft rejection
Sarah Demir1, Julien Saison2, Agathe Sénéchal1, Jean-Francois Mornex3
1 Department of Pulmonary Diseases, Lyon University Hospital System, Louis Pradel Hospital, F-69003, Lyon, France
2 Department of Infectious Diseases, Lyon University Hospital System, Croix Rousse Hospital, F-69004; International Center for Infectiology Research, Inserm U1111, Lyon 1 University, F-69007, Lyon, France
3 Department of Pulmonary Diseases, Lyon University Hospital System, Louis Pradel Hospital, F-69003; Viral Infections and Comparative Pathology, INRA UMR 754, Lyon 1 University, F-69007, Lyon, France
Department of Pulmonary, Louis Pradel Hospital, Hospices Civils de Lyon, F-69500, Bron
Source of Support: None, Conflict of Interest: None
A 40-year-old cystic fibrosis woman with a history of double-lung transplantation 2 years previously was admitted for a progressive respiratory distress. Physical examination revealed fever (39°C) and diffuse bilateral lung crackles. Laboratory findings included severe hypoxemia and inflammatory syndrome. Bronchoalveolar lavage and serological test were positive for mycoplasma pneumonia. As the patient did not improve after 3 days of antibiotics and donor-specific HLA antibodies had been detected, an acute antibody-mediated graft rejection was treated with high-dose corticosteroids, plasma exchange, intravenous immunoglobulin, and rituximab. The patient rapidly improved. Unfortunately, 6 months after this episode, she developed a bronchiolitis obliterans syndrome with a dependence to noninvasive ventilator leading to the indication of retransplantation. This case illustrates the possible relationship between infection and humoral rejection. These two diagnoses should be promptly investigated and systematically treated in lung transplant recipients.