{
  "abstract": "Introduction: Early pulmonary complications after allogeneic hematopoietic stem cell transplantation (HSCT) are diagnostically challenging because opportunistic infection, inflammatory toxicity, diffuse alveolar injury, and noninfectious syndromes may overlap. Idiopathic pneumonia syndrome is a diagnosis of exclusion, defined by diffuse lung injury, hypoxemia, and absence of a predominant infectious, cardiogenic, or fluid-overload cause. Case report: A 25-year-old woman with B-cell acute lymphoblastic leukemia underwent allogeneic haploidentical HSCT, after conditioning with fludarabine, melphalan, and total body irradiation. She received a peripheral blood stem cell graft containing 5.24 × 10⁶ CD34+ cells/kg. Around day +27, she developed cough, tachypnea, and new-onset hypoxemia. Chest computed tomography showed extensive bilateral confluent centrilobular ground-glass opacities with mild septal thickening, without pleural effusion or pneumothorax, and with a small pericardial effusion. An extensive infectious workup was performed. The molecular respiratory viral panel was negative for adenovirus, bocavirus, seasonal coronaviruses, SARS-CoV-2, enterovirus, metapneumovirus, rhinovirus, influenza A/B, parainfluenza, respiratory syncytial virus, Mycoplasma pneumoniae, and Bordetella spp. She was receiving acyclovir and letermovir prophylaxis, plus therapeutic-dose trimethoprim-sulfamethoxazole and levofloxacin for Stenotrophomonas maltophilia. CMV monitoring showed transient low-level positivity, subsequently below the lower limit of detection. She also received meropenem, liposomal amphotericin B, vancomycin, and polymyxin B, in the context of previous catheter-related bloodstream infection by Enterococcus faecium and S. maltophilia. Bronchoalveolar lavage bacterial culture was negative. BAL galactomannan index was 1.048, borderline and slightly above the positivity cutoff; however, the clinical-radiological pattern did not support a predominant invasive fungal disease, although antifungal coverage was maintained as a precaution. She required intensive care and sedation, with progressive hypoxemia and worsening PaO₂/FiO₂ ratio, consistent with severe acute respiratory distress syndrome, requiring lung-protective ventilation and prone positioning, with partial improvement after the maneuver. Discussion: This case illustrates the complexity of classifying acute hypoxemia with diffuse pulmonary infiltrates early after HSCT. Timing, new hypoxemia, bilateral ground-glass pattern, negative extended viral panel, and absence of findings strongly suggestive of invasive fungal disease favored post-transplant noninfectious pneumonitis within the spectrum of idiopathic pneumonia syndrome. Borderline BAL galactomannan positivity required caution, since opportunistic infection and inflammatory lung injury may coexist. Management integrated ventilatory support, broad-spectrum antimicrobials, systemic antifungal therapy, exclusion of cardiogenic or fluid-overload causes, and early consideration of a noninfectious pulmonary complication. Conclusion: In allogeneic HSCT recipients, early hypoxemia with diffuse ground-glass opacities requires broad investigation and integrated management. Noninfectious pneumonitis/idiopathic pneumonia syndrome should be considered when the initial infectious workup is inconclusive and the clinical-radiological pattern does not support a predominant infectious etiology.",
  "abstract_shown": true,
  "affiliations": [
    "Rede Materdei Saúde, Belo Horizonte, MG, Brazil"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Lucas De Barros ANASTACIO"
    },
    {
      "affs": [
        0
      ],
      "name": "Cássia Caetano de Oliveira MIRANDA"
    },
    {
      "affs": [
        0
      ],
      "name": "Anderson Martins PEREIRA"
    },
    {
      "affs": [
        0
      ],
      "name": "Wellington Morais de AZEVEDO"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6xy8hx6dmes1a.bib",
  "cited_by": 0,
  "doi": "10.1016/j.htct.2026.106859",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2531137926006061",
  "id": "6xy8hx6dmes1a",
  "issns": [
    "2531-1379",
    "2531-1387"
  ],
  "landing_url": "https://doi.org/10.1016/j.htct.2026.106859",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC633-647.5"
    ],
    [
      "openalex",
      "2720|Hematopoietic Stem Cell Transplantation"
    ]
  ],
  "openalex": "W7223138215",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/6xy8hx6dmes1a.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:43:25Z",
      "native_id": "553e0d07aae543a4b25a0dcb132c1646",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.htct.2026.106859"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC633-647.5",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "EARLY HYPOXEMIA WITH DIFFUSE GROUND-GLASS OPACITIES AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION: DIAGNOSTIC CHALLENGE BETWEEN NONINFECTIOUS PNEUMONITIS AND OPPORTUNISTIC INFECTION",
  "title_text": "EARLY HYPOXEMIA WITH DIFFUSE GROUND-GLASS OPACITIES AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION: DIAGNOSTIC CHALLENGE BETWEEN NONINFECTIOUS PNEUMONITIS AND OPPORTUNISTIC INFECTION",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:25Z",
  "url": "https://research.draconitic.com/paper/6xy8hx6dmes1a",
  "venue": "Hematology, Transfusion and Cell Therapy",
  "versions": []
}