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Tracheobronchomalacia after allogeneic BMT; pulmonary function test findings similar to those of bronchiolitis obliterans

Bone Marrow Transplantation volume 49, pages 1450–1451 (2014)Cite this article

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Tracheobronchomalacia (TBM) is a rare disease caused by weakness of the trachea and bronchi due to softening of the supporting cartilage and hypotonia of myoelastic elements.1,2 We present two cases of TBM that were diagnosed after allogeneic BMT.

The first case was that of a 56-year-old male myelodysplastic syndrome patient who underwent BMT from an unrelated, HLA-matched donor in March 2008. After tapering of tacrolimus, extensive chronic GVHD (cGVHD) developed in November 2008 and resolved by January 2009 with the administration of prednisolone (PSL) and tacrolimus. In April 2009, the patient developed a cough and complained of dyspnoea on exertion. There were no abnormal findings on X-ray or computed tomography (CT) examinations of the chest. The dyspnoea reported by the patient worsened, and the level of the forced expiratory volume in 1 s divided by the forced vital capacity (FEV1/FVC%) fell to 43.2% (Supplementary Figure 1). The residual lung volume increased to 147%, in contrast with 74.3% observed in November 2007. He was diagnosed with bronchiolitis obliterans (BO) without performing an additional high-resolution CT (HRCT) scan because his pulmonary function tests (PFTs) revealed obvious airway obstruction with a residual volume >120%, and his chest CT scan did not indicate any respiratory infection or cryptogenic organising pneumonia. Treatment with inhaled budesonide and salmeterol, oral PSL and tacrolimus improved his symptoms; however, the symptoms did not resolve.

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Authors and Affiliations

  1. Division of Haematology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Japan

    J Watanabe, K Sato, T Horiuchi, S Kato, R Hikota, T Maekawa, T Yamamura, A Kobayashi, S Kobayashi & F Kimura

  2. Division of Infectious Disease and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Japan

    Y Fujikura & A Kawana

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  1. J Watanabe
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  2. K Sato
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  3. Y Fujikura
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  4. T Horiuchi
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  6. R Hikota
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  7. T Maekawa
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  10. S Kobayashi
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  11. A Kawana
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  12. F Kimura
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Correspondence to J Watanabe.

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Watanabe, J., Sato, K., Fujikura, Y. et al. Tracheobronchomalacia after allogeneic BMT; pulmonary function test findings similar to those of bronchiolitis obliterans. Bone Marrow Transplant 49, 1450–1451 (2014). https://doi.org/10.1038/bmt.2014.175

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