Thorax 1982;37:77-78 Fatal airway disease in an adult with chronic graft-versus-host disease

Chronic graft-versus-host disease (GVHD) is a syndrome of disordered immunity in which a variety of oppor-tunistic respiratory infections have been documented. Restrictive pulmonary disease without advanced fibrotic changes has been also known to occur; obstructive lower airways disease related to chronic GVHD has apparently not been referred to. ' 2We report a patient with chronic GVHD and irreversible airways obstruction who died in respiratory failure caused by generalised bronchiolar damage progressing over a few months. Lung function studies showed severe airflow limitation and a leftward shift in the pressure-volume curve indicating a loss of elastic recoil pressure. Postmortem pulmonary lesions were consistent with a necrotising obliterative bron-chiolitis. Our purpose is to describe this unusual compli-cation not previously reported in chronic GVHD and discuss the pulmonary mechanics. Case report A 22-year-old white man received an allogeneic bone marrow graft for aplastic anaemia.The donor was an HLA-identical (MLC-negative) sibling. The evidence of a functioning allograft was confirmed by red cell antigens by day 80. In spite of prophylactic administration of methotrexate, the patient developed by day 36 a mild generalised maculo-erythematous rash, which disap