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Pulmonary, Critical Care, and Sleep Pearls |

A 48-Year-Old Man With Leukopenia, Jaundice, and Skin Rash After Lung Transplantation

Ali Ataya, MD; Abhishek Biswas, MD; Satish Chandrashekaran, MD; Juan C. Salgado, MD; Steven S. Goldstein, MD; Amir M. Emtiazjoo, MD
Author and Funding Information

This case was presented as an oral presentation at the International Society for Heart and Lung Transplantation (ISHLT) annual meeting in Nice, France, April 2015.

aDivision of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL

bDepartment of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL

CORRESPONDENCE TO: Amir M. Emtiazjoo, MD, University of Florida, 1600 SW Archer Rd, M452, PO Box 100225, Gainesville, FL 32610


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):e167-e170. doi:10.1016/j.chest.2016.05.017
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A 48-year-old African-American male subject presented with progressive fatigue, jaundice, and new-onset leukopenia 12 weeks after undergoing bilateral lung transplantation for advanced pulmonary sarcoidosis. His transplant surgery and immediate posttransplantation course were uneventful. Induction immunosuppression included methylprednisolone 500 mg intraoperatively and basiliximab (anti-IL-2 monoclonal antibody) on days 0 and 4 after transplantation. His maintenance immunosuppression posttransplantation was prednisone 20 mg daily, tacrolimus with target tacrolimus levels 10 to 15 ng/mL, and mycophenolate mofetil 750 mg twice daily. Both the donor and recipient were seropositive for cytomegalovirus and Epstein-Barr virus. Infectious disease prophylaxis consisted of valganciclovir, trimethoprim/sulfamethoxazole, and voriconazole. Results of the surveillance bronchoscopy conducted after the lung transplant were negative for acute cellular rejection or infection at 4 and 12 weeks’ posttransplantation. Findings on spirometry had continuously improved since transplantation.

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