Bronchiolitis obliterans organizing pneumonia (BOOP) has been described after bone marrow, lung, heart-lung, and
renal transplantation, but rarely after orthotopic
liver transplantation (OLT). We report a case of BOOP after OLT to emphasize BOOP as an under diagnosed and treatable cause of nonresolving
pneumonia, which may not be preventable by maintenance low-dose
prednisone. A 48-year-old man was hospitalized for
dyspnea and
cough one month after OLT. Among his medications were
tacrolimus and
prednisone. Physical examination was significant for lung crepitations and bilateral leg
edema. Chest x-ray revealed bilateral infiltrates. Computed tomography (CT) of the chest demonstrated bilateral diffuse infiltrates with areas of sparing and nodularities. Bronchoscopy was normal and bronchoalveolar lavage was negative. Lung biopsy was performed and demonstrated serpiginous plugs of fibroblastic tissue filling the alveolar spaces, focal
fibrosis of some alveolar septa, and reactive pneumocytic
hyperplasia consistent with BOOP.
Methylprednisolone was continued with clinical improvement and weaning from the
ventilator, but subsequent
sepsis and multisystem organ failure finally led to the patient's death.