The Use of Bilateral Orthotopic Lung Transplantation in the Management of Acute Severe Drug-induced Interstitial Lung Disease – A Case Report

This case report presents a unique and severe manifestation of drug-induced interstitial lung disease (DIILD) in an 18-year-old male with a recent history of COVID- 19 infection. The patient, treated with trimethoprim-sulfamethoxazole (Bactrim) for acne, developed a rapid and aggressively progressive respiratory failure and underwent bilateral orthotopic lung transplantation. Radiologic evaluation revealed extensive bilateral bronchiectasis, ground glass opacities/consolidation, and fibrotic changes, with diffuse vascular thrombosis observed during explant pathology. Sulfonamides, particularly Bactrim, are implicated in DIILD, with male sex and preexisting lung disease as common risk factors. The patient's simultaneous exposure to COVID-19 and genetic susceptibility to Bactrim allergy (HLA B07:02 and HLA C07:02) may have contributed to the rapid progression of pulmonary fibrosis. Despite limited literature on lung transplantation for Bactrim-induced lung fibrosis, this case underscores its consideration as a viable treatment option in refractory cases