Pulmonary veno-occlusive disease, a rare but fatal complication among patients with hematologic malignancy
Keywords:
pulmonary veno-occlusive disease, hematopoietic stem cell transplantation, alkylating agentAbstract
Pulmonary veno-occlusive disease (PVOD), classified as group 1 pulmonary hypertension, is a rare but fatal form of pulmonary artery hypertension (PAH) manifesting subacute to chronic progressive dyspnea due to the increase in pulmonary arterial pressure and right-side heart failure. Exposure to chemotherapy and poststem cell transplantation constitute risk factors of PVOD. We herein demonstrate a case of PVOD in a middle-aged female with the underlying disease of T-cell/histiocyte-rich large B cell lymphoma treated using an alkylating agent and hematopoietic stem cell transplantation and presenting biventricular heart failure. After being treated using methylprednisolone, diuresis and pulmonary vasodilators, her clinical symptoms transiently improved. Unfortunately, the patient passed away one year after the diagnosis due to the progression of right-sided heart failure. Necropsy of the lung was performed revealing the occlusion of pulmonary venules.
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Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J. 2015;46:903-75.
Bunte MC, Patnaik MM, Pritzker MR, Burns LJ. Pulmonary veno-occlusive disease following hematopoietic stem cell transplantation: a rare model of endothelial dysfunction. Bone Marrow Transplantation. 2008;41:677-86.
Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, et al. Pulmonary arterial hypertension in France: results from a national registry. American journal of respiratory and critical care medicine. 2006;173:1023-30.
Troussard X, Bernaudin JF, Cordonnier C, Fleury J, Payen D, Briere J, et al. Pulmonary veno-occlusive disease after bone marrow transplantation. Thorax. 1984;39:956-7.
Pietra GG, Capron F, Stewart S, Leone O, Humbert M, Robbins IM, et al. Pathologic assessment of vasculopathies in pulmonary hypertension. Journal of the American College of Cardiology. 2004;43(Suppl 12):25s-32s.
Holcomb BW, Jr., Loyd JE, Ely EW, Johnson J, Robbins IM. Pulmonary veno-occlusive disease: a case series and new observations. Chest. 2000;118:1671-9.
Ranchoux B, Gunther S, Quarck R, Chaumais MC, Dorfmuller P, Antigny F, et al. Chemotherapy-induced pulmonary hypertension: role of alkylating agents. Am J Pathol. 2015;185:356-71.
Levy M, Moshous D, Szezepanski I, Galmiche L, Castelle M, Lesage F, et al. Pulmonary hypertension after bone marrow transplantation in children. Eur Respir J. 2019;54.
Eyries M, Montani D, Girerd B, Perret C, Leroy A, Lonjou C, et al. EIF2AK4 mutations cause pulmonary veno-occlusive disease, a recessive form of pulmonary hypertension. Nat Genet. 2014;46:65-9.
Hadinnapola C, Bleda M, Haimel M, Screaton N, Swift A, Dorfmuller P, et al. Phenotypic Characterization of EIF2AK4 Mutation Carriers in a Large Cohort of Patients Diagnosed Clinically with Pulmonary Arterial Hypertension. Circulation. 2017;136:2022-33.
Montani D, Lau EM, Dorfmüller P, Girerd B, Jaïs X, Savale L, et al. Pulmonary veno-occlusive disease. European Respiratory Journal. 2016;47:1518.
Montani D, Achouh L, Dorfmüller P, Le Pavec J, Sztrymf B, Tchérakian C, et al. Pulmonary veno-occlusive disease: clinical, functional, radiologic, and hemodynamic characteristics and outcome of 24 cases confirmed by histology. Medicine. 2008;87:220-33.
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