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JAMA Oncology Clinical Challenge
December 2016

Respiratory Failure in a Woman 8 Months After an Allogeneic Stem Cell Transplant

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Division of Infectious Diseases, University of California, San Francisco
JAMA Oncol. 2016;2(12):1651-1652. doi:10.1001/jamaoncol.2016.2642

A 67-year-old woman with a history of peripheral T-cell lymphoma after an allogeneic stem cell transplant (SCT) presented with 3 days of fever, weakness, and dyspnea.

She was diagnosed with stage IV peripheral T-cell lymphoma 3 years prior and was initially treated with gemcitabine, vinorelbine, and doxorubicin. Her disease recurred 1 year later, and she underwent haplotype-matched allogeneic SCT 8 months prior to admission. Two months prior to admission, she developed graft-vs-host disease requiring high-dose prednisone, rituximab, and intravenous immunoglobulin. At the time of admission, she was receiving prednisone (40 mg/d) and tacrolimus for graft-vs-host disease and prophylaxis of infection with levofloxacin, valacyclovir, posaconazole, and thrice weekly dapsone. The patient lived with her family, including her son who recently had a cough. She was born in the Philippines and immigrated to the United States 3 decades prior. She denied recent travel.

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