Recurrent diffuse panbronchiolitis after lung transplantation: Off-label use of inhaled tobramycin for Pseudomonas aeruginosa control in a transplant recipient

Objectives: This report highlights a clinical case of recurrent diffuse panbronchiolitis (DPB) after bilateral lung transplantation (LTx), with a focus on the therapeutic impact of off-label inhaled tobramycin solution for inhalation (TSI) in managing Pseudomonas aeruginosa colonization. Methods: A...

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Main Authors: Shin Tanaka, Tuyoshi Ryuko, Yasuaki Tomioka, Kazuhiko Shien, Ken Suzawa, Kentaroh Miyoshi, Hideharu Hagiya, Mikio Okazaki, Seiichiro Sugimoto, Shinichi Toyooka
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:International Journal of Infectious Diseases
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Online Access:http://www.sciencedirect.com/science/article/pii/S1201971225001365
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author Shin Tanaka
Tuyoshi Ryuko
Yasuaki Tomioka
Kazuhiko Shien
Ken Suzawa
Kentaroh Miyoshi
Hideharu Hagiya
Mikio Okazaki
Seiichiro Sugimoto
Shinichi Toyooka
author_facet Shin Tanaka
Tuyoshi Ryuko
Yasuaki Tomioka
Kazuhiko Shien
Ken Suzawa
Kentaroh Miyoshi
Hideharu Hagiya
Mikio Okazaki
Seiichiro Sugimoto
Shinichi Toyooka
author_sort Shin Tanaka
collection DOAJ
description Objectives: This report highlights a clinical case of recurrent diffuse panbronchiolitis (DPB) after bilateral lung transplantation (LTx), with a focus on the therapeutic impact of off-label inhaled tobramycin solution for inhalation (TSI) in managing Pseudomonas aeruginosa colonization. Methods: A Japanese woman with a history of DPB experienced disease recurrence following bilateral LTx. Persistent colonization by P. aeruginosa and recurrent respiratory symptoms were observed. Off-label TSI therapy, commonly used in cystic fibrosis, was introduced. Clinical response was assessed through radiologic imaging, bronchoscopy, and microbiological cultures. Results: TSI administration led to significant clinical and radiological improvement. P. aeruginosa was eradicated from sputum cultures within one month and remained absent throughout six months of follow-up. No hospitalizations or adverse events were reported during therapy. Conclusion: This case suggests the potential of TSI as a therapeutic approach for managing recurrent DPB and indicates its role in stabilizing post-transplant outcomes. Further studies may clarify its efficacy and expand its application in broader DPB management strategies.
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institution DOAJ
issn 1201-9712
language English
publishDate 2025-07-01
publisher Elsevier
record_format Article
series International Journal of Infectious Diseases
spelling doaj-art-98ffa5f36a7f476ea03c93741c1c83582025-08-20T03:11:26ZengElsevierInternational Journal of Infectious Diseases1201-97122025-07-0115610791310.1016/j.ijid.2025.107913Recurrent diffuse panbronchiolitis after lung transplantation: Off-label use of inhaled tobramycin for Pseudomonas aeruginosa control in a transplant recipientShin Tanaka0Tuyoshi Ryuko1Yasuaki Tomioka2Kazuhiko Shien3Ken Suzawa4Kentaroh Miyoshi5Hideharu Hagiya6Mikio Okazaki7Seiichiro Sugimoto8Shinichi Toyooka9Department of General Thoracic and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan; Corresponding author: Shin Tanaka, Department of Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, Kita-ku, Okayama 700-8558, Japan.Department of General Thoracic and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, JapanDepartment of General Thoracic and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of General Thoracic and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of General Thoracic and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of General Thoracic and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Infectious Diseases, Okayama University Hospital, Okayama, JapanDepartment of General Thoracic and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of General Thoracic and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, JapanDepartment of General Thoracic and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanObjectives: This report highlights a clinical case of recurrent diffuse panbronchiolitis (DPB) after bilateral lung transplantation (LTx), with a focus on the therapeutic impact of off-label inhaled tobramycin solution for inhalation (TSI) in managing Pseudomonas aeruginosa colonization. Methods: A Japanese woman with a history of DPB experienced disease recurrence following bilateral LTx. Persistent colonization by P. aeruginosa and recurrent respiratory symptoms were observed. Off-label TSI therapy, commonly used in cystic fibrosis, was introduced. Clinical response was assessed through radiologic imaging, bronchoscopy, and microbiological cultures. Results: TSI administration led to significant clinical and radiological improvement. P. aeruginosa was eradicated from sputum cultures within one month and remained absent throughout six months of follow-up. No hospitalizations or adverse events were reported during therapy. Conclusion: This case suggests the potential of TSI as a therapeutic approach for managing recurrent DPB and indicates its role in stabilizing post-transplant outcomes. Further studies may clarify its efficacy and expand its application in broader DPB management strategies.http://www.sciencedirect.com/science/article/pii/S1201971225001365Inhaled tobramycinLung transplantationPseudomonas aeruginosaRecurrent diffuse panbronchiolitis
spellingShingle Shin Tanaka
Tuyoshi Ryuko
Yasuaki Tomioka
Kazuhiko Shien
Ken Suzawa
Kentaroh Miyoshi
Hideharu Hagiya
Mikio Okazaki
Seiichiro Sugimoto
Shinichi Toyooka
Recurrent diffuse panbronchiolitis after lung transplantation: Off-label use of inhaled tobramycin for Pseudomonas aeruginosa control in a transplant recipient
International Journal of Infectious Diseases
Inhaled tobramycin
Lung transplantation
Pseudomonas aeruginosa
Recurrent diffuse panbronchiolitis
title Recurrent diffuse panbronchiolitis after lung transplantation: Off-label use of inhaled tobramycin for Pseudomonas aeruginosa control in a transplant recipient
title_full Recurrent diffuse panbronchiolitis after lung transplantation: Off-label use of inhaled tobramycin for Pseudomonas aeruginosa control in a transplant recipient
title_fullStr Recurrent diffuse panbronchiolitis after lung transplantation: Off-label use of inhaled tobramycin for Pseudomonas aeruginosa control in a transplant recipient
title_full_unstemmed Recurrent diffuse panbronchiolitis after lung transplantation: Off-label use of inhaled tobramycin for Pseudomonas aeruginosa control in a transplant recipient
title_short Recurrent diffuse panbronchiolitis after lung transplantation: Off-label use of inhaled tobramycin for Pseudomonas aeruginosa control in a transplant recipient
title_sort recurrent diffuse panbronchiolitis after lung transplantation off label use of inhaled tobramycin for pseudomonas aeruginosa control in a transplant recipient
topic Inhaled tobramycin
Lung transplantation
Pseudomonas aeruginosa
Recurrent diffuse panbronchiolitis
url http://www.sciencedirect.com/science/article/pii/S1201971225001365
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