CTICasesGraft-Versus-Host Disease (GVHD)
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Imaging findings
High-resolution chest CT shows mild cylindrical bronchiectasis and subtle mosaic attenuation consistent with constrictive bronchiolitis. Subsequent CT scans demonstrate rapid clinical progression with patchy peribronchial consolidation, peripheral organizing pneumonia, and necrotizing parenchymal changes resembling cavitation. Lung biopsy confirmed necrotizing and organizing pneumonia without identifiable infectious organisms.
Key takeaways
Graft-versus-host disease (GVHD) in stem cell transplant recipients typically manifests in the lungs as constrictive (obliterative) bronchiolitis with bronchiectasis and mosaic perfusion. However, it can also present with atypical, aggressive, non-infectious inflammatory manifestations such as organizing pneumonia and sterile necrotizing pneumonia, which can be rapidly progressive and refractory to immunosuppressive therapy.
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