Pulmonary Infection in a Patient After Stem Cell Transplantation

A 69-year-old man with a history of hypertension, diabetes mellitus, and acute myelogenous leukemia presented with recurrent fever and cough. He had undergone allogeneic hematopoietic stem cell transplantation from a matched unrelated donor 17 months previously. His posttransplant course was complicated by graft versus host disease and multiple central venous catheter infections with coagulase-negative Staphylococcus spp., vancomycin-resistant Enterococcus, Lactobacillus, and alpha-hemolytic Streptococcus. During his initial course, he also developed a nodular pneumonia, and the subsequent workup included a bronchoscopy that was nondiagnostic.