Korean J Crit Care Med.  2016 May;31(2):146-151. 10.4266/kjccm.2016.31.2.146.

Lung Transplantation for Chronic Humidifier Disinfectant-Associated Lung Injury

• Kim WY
• Kim SW
• Jo KW
• Choi SH
• Kim HR
• Kim YH
• Kim DK
• Park SI
• Hong SB

• KMID: 2350923
• DOI: http://doi.org/10.4266/kjccm.2016.31.2.146

Abstract

In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient's clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.

Keyword

disinfectants; humidifiers; inhalation exposure; lung transplantation; oxygen inhalation therapy

MeSH Terms

Adult
Catheters
Disinfectants
Extracorporeal Membrane Oxygenation
Female
Fibrosis
Humans
Humidifiers*
Inhalation
Inhalation Exposure
Intensive Care Units
Korea
Lung Injury*
Lung Transplantation*
Lung*
Oxygen Inhalation Therapy
Respiration, Artificial
Survivors
Disinfectants

Figure

• 

  Fig. 1. The three stages of humidifier disinfectant-associated lung injury in a 33-year-old woman. (A) Initial computed tomography (CT) scan revealing diffuse, centrilobular ground-glass opacity (GGO) nodules with patchy multifocal consolidations. (B) On the CT obtained on the day of admission to our hospital, the consolidations disappeared, but diffuse GGO nodules became more distinct (lower), with newly appeared GGOs in both upper lobes (upper). (C) Follow-up CT scan obtained two weeks after exhibited improved GGOs in both upper lobes (upper), but diffuse GGO nodules and pneumomediastinum remained (lower). A small amount of left pneumothorax is also visible (upper).

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  Fig. 2. The patient’s disease course after discharge. (A-C) Follow-up computed tomography (CT) scans exhibited residual diffuse centrilobular ground-glass opacity nodules and multiple air cysts with parenchymal distortion and fibrosis. (D) Normal CT scans two months after lung transplantation.

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  Fig. 3. Serial pulmonary function test findings showing a decline that persisted during follow-up. After the lung transplantation, these findings were significantly improved. LTPL: lung transplantation; FVC: forced vital capacity; FEV1: forced expiratory volume in 1 s; DLCO: diffusing capacity of lung for carbon monoxide.

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  Fig. 4. Pathology of the explanted lungs. (A) Centrilobular and patchy fibrosis with honeycomb changes (H&E stain, ×10). Characteristically, the lung architecture was destroyed and replaced by irregular cystic sacs with dense fibrotic walls. (B) Patchy, interstitial lymphoid cellular infiltration with fibrosis of the bronchioles (H&E stain, ×40).

Reference

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