Case Reports and Reviews: Open Access

Abstract 

Hematopoietic stem cell transplantation (HSCT) is an essential therapy for malignant and non-malignant hematologic, autoimmune, and genetic disorders. However, post-transplant complications, particularly pulmonary infections, remain a leading cause of morbidity and mortality. Case report: We present the case of a 70-year-old male with chronic lymphocytic leukemia (CLL) who underwent allogeneic HSCT several years ago. Post-transplant, he received intravenous immunoglobulin (IVIG) every six weeks for immune support. Despite this, he developed chronic obstructive pulmonary disease (COPD) without any smoking history and has experienced recurrent pneumonia requiring frequent hospitalizations. Extensive microbiologic and imaging evaluations repeatedly failed to identify a causative organism. The patient remains on chronic antibiotic therapy, nebulized bronchodilators, and antiviral prophylaxis with valacyclovir. This case underscores the vulnerability of post-HSCT patients to recurrent, often unexplained pulmonary infections despite ongoing prophylactic and supportive measures. Management focuses on infection prevention and treatment through broad-spectrum antimicrobials, immunoglobulin replacement, and respiratory support, while addressing physical, psychological, and nutritional needs. Discussion: In patients with CLL and T-cell-depleted HSCT, persistent immunodeficiency can lead to refractory pulmonary complications, significantly reducing quality of life and survival. Early recognition, aggressive management, and multidisciplinary care are essential to improving outcomes in this high-risk population.
 

Keywords: Hematopoietic Stem cell transplantation; Chronic lymphocytic leukemia; Pulmonary complications; Infections; Transplantation; Intravenous immunoglobulin; Graft-Versus-Host Disease.