Abstract
Noninfectious pulmonary complications are a significant cause of morbidity and mortality
in immunocompromised patients, particularly in those undergoing hematopoietic stem
cell transplantation, solid organ transplantation, chemotherapy, or immunotherapy.
These syndromes often mimic infections, leading to delayed diagnosis and inappropriate
treatment. Acute complications include peri-engraftment respiratory distress syndrome,
diffuse alveolar hemorrhage, drug-induced lung injury, immune checkpoint inhibitor-related
pneumonitis, and radiation pneumonitis, while late or chronic complications, such
as organizing pneumonia, interstitial lung disease, bronchiolitis obliterans syndrome,
and chronic graft-versus-host disease-related lung involvement, typically develop
months to years after therapy. Accurate and timely diagnosis is essential, relying
on high-resolution CT, bronchoalveolar lavage, and, in selected cases, lung biopsy
to differentiate these conditions from infections. Current treatments remain largely
empirical, focusing on corticosteroids, supportive intensive care, and immunosuppressive
adjustment, although novel strategies, including inhaled hemostatic agents and JAK
inhibitors, are emerging. Despite advances in supportive management, late-onset complications
remain associated with poor long-term functional outcomes. Future directions include
the development of biomarkers, artificial intelligence-assisted radiological tools,
and multicenter registries to improve classification, risk stratification, and treatment.
In this narrative review, we highlight current evidence around noninfectious pulmonary
complications in the critical care setting, diagnosis, and treatment.
Keywords
noninfectious pulmonary complications - acute respiratory distress syndrome - respiratory
failure - organizing pneumonia - pneumonia
