Case reportEffect of Azithromycin on Bronchiectasis and Pulmonary Function in a Heart-Lung Transplant Patient With Severe Chronic Allograft Dysfunction: A Case Report
Section snippets
Case report
A 16-year-old girl with Eisenmenger’s syndrome underwent a heart-lung transplantation in 1991. This procedure was complicated by a bilateral diaphragm paresis, acute renal insufficiency, and several acute rejection episodes that required high doses of intravenous corticosteroids on at least 3 occasions during the first 2 post-operative months. The patient’s maintenance immunosuppressive treatment consisted of cyclosporin, azathioprine, and oral corticosteroids. Her FEV1 gradually improved to
Discussion
We report this unique case of a heart-lung transplant patient, thought to have irreversible BOS as demonstrated by the declining FEV1, the appearance of bronchiectasis, and the colonization pattern of the airways with gram-negative rods and fungi, who not only had significantly improved FEV1 during treatment with azithromycin, but also seems to have had a major improvement of the bronchiectasis. Although the spiral CT scanning technique that was used is not ideal for the detection of
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Cited by (28)
The Use of Antiinflammatory Therapy and Macrolides in Bronchiectasis
2012, Clinics in Chest MedicineCitation Excerpt :There was also a significant decrease in exacerbations in the patients (P<.001), as well as a clinically significant decrease in sputum microbial isolates. Two additional single case studies documented benefit of azithromycin in either idiopathic bronchiectasis or bronchiectasis associated with chronic rejection in a heart-lung transplant recipient.56,57 An overview of all the studies documenting the effects of macrolides in patients with bronchiectasis is demonstrated in Table 2.
Azithromycin Attenuates Effects of Lipopolysaccharide on Lung Allograft Bronchial Epithelial Cells
2008, Journal of Heart and Lung TransplantationCitation Excerpt :Clinical use of azithromycin from three centers, including our own institution, demonstrated significant improvements in patients with the OB.17–19 In a further case report, addition of azithromycin resulted in an improvement in bronchiectesis in a post-transplant patient.50 Such findings are encouraging given the devastating nature of the problem and there is now an urgent need for translational mechanistic studies on macrolide therapy for selected patients.51
Anti-inflammatory effects of azithromycin in cystic fibrosis airway epithelial cells
2006, Biochemical and Biophysical Research CommunicationsCitation Excerpt :AZM is receiving increasing interest for its therapeutic benefits in the treatment of CF. Equi et al. reported promising clinical effects without significant changes of IL-8 and neutrophil elastase levels in sputa of CF patients following treatment with AZM [36]. However our results are consistent with the reduction of IL-8 release described after lung transplantation, supporting anti-inflammatory properties of this macrolide [37–40]. The molecular basis of this effect has been more thoroughly investigated.
Immunomodulatory effects of antibacterial agents
2006, ReanimationLung structure abnormalities, but normal lung function in pediatric bronchiectasis
2006, ChestCitation Excerpt :Actually, improvement following appropriate therapeutic interventions was demonstrated by the studies of Field46 reporting a fall in the annual hospitalization rate after medical or surgical treatment. Two anecdotal reports4748 of non-CF patients have shown near resolution of bronchiectasis after treatment with Nissen fundoplication plus gastrostomy in a child with chronic aspiration47 or after a course of azithromycin therapy in an adolescent patient who had undergone a heart-lung transplant with chronic lung rejection.48 Another report49 of 33 patients with bronchiectasis has shown that long-term treatment with azithromycin resulted in a significant reduction of infectious exacerbations, and in the improvement of several lung function parameters and clinical symptoms.