HPI: This is a 26 year old female patient with a history of cystic fibrosis, who underwent a bilateral sequential single lung transplant on 3/18/94 with subsequent chronic rejection and progressively incapacitating obliterative bronchiolitis. She received a repeat BSLTx two years later with the post-operative period complicated by intrathoracic bleeding, that twice required mediastinal exploration, and was finally discharged more than two weeks later. Bronchoscopic biopsies one month after re-transplant revealed grade A0B0 (no significant acute) rejection and she had been well until the above symptoms developed three weeks after biopsy. Her respiratory function by spirometry was stable, and she denied any additional symptoms such as prior fever, dysuria, nausea, headache, vomiting or diarrhea. During the last bronchoscopy, the question of silent aspiration was raised and on close questioning at the time of this admission, some difficulty in swallowing was acknowledged.

Medications: tacrolimus 1 mg BID, itraconazole 400 mg daily, prednisone 20 mg daily, flunisolide MDI 2 p BID, dapsone 100 mg TID, digoxin 0.125 mg daily, diltiazem 60 mg TID, erythropoietin MWF, ganciclovir 1 g TID, famotidine 40 mg daily, albuterol MDI TID, pancrease, Vit C, Vit D, MVI.

Allergies: Sulfa, ciprofloxacin, pentoxifylline, amox/clav, codeine

PMH: left vocal cord paresis, S. aureus sepsis, pulmonary embolism with IVC filter. Lung transplant, donor CMV negative, recipient positive; repeat transplant donor positive.

Social and occupational Hx: G1 P0010, non-contributory, no tobacco or alcohol

Travel history and pets and hobbies: none