Identifying and Treating Burkholderia Cepacia Complex in Bilateral Lung Transplant Recipients: Implications for Acute Rehabilitation

Case Diagnosis: This case describes a 70-year-old lung transplant recipient with Burkholderia cepacia pneumonia, who developed respiratory failure but achieved significant functional recovery through a comprehensive inpatient rehabilitation program following targeted antimicrobial therapy.

Case Description or Program Description: A 70-year-old female with a history of bilateral lung transplant for COPD and breast cancer presented with progressive weakness, right upper quadrant pain, and lethargy. Labs revealed hyperkalemia, acute kidney injury, transaminitis, and elevated tacrolimus levels. Imaging showed bilateral pleural effusions, requiring thoracentesis. The patient developed respiratory distress, and bronchoalveolar lavage confirmed Burkholderia cepacia complex (BCC). She was transferred to the ICU, intubated, and treated with IV meropenem, inhaled tobramycin, and azithromycin.

Setting: Acute In-Patient rehabilitation.

Assessment/Results: The patient had significant functional impairments, requiring maximum assistance for all ADLs, transfers, and ambulation. A comprehensive rehabilitation program, including respiratory muscle strength training, neuromuscular stimulation, and mobility exercises, improved pulmonary function, endurance, and strength. By discharge, she achieved supervised independence in ADLs, transfers, and ambulation.

Discussion (relevance): Burkholderia cepacia complex (BCC) is a rare but serious infection in lung transplant recipients (1-3% incidence), with 30-50% post-transplant mortality. Its intrinsic antibiotic resistance complicates treatment. This patient’s isolate was meropenem-sensitive, allowing for targeted therapy and improved outcomes.

Conclusions: This case highlights the complexity of BCC pneumonia in lung transplant recipients, emphasizing early identification and targeted antimicrobial therapy. Despite severe functional impairments at admission, a structured rehabilitation program, including respiratory training and neuromuscular stimulation, significantly improved recovery. With continued outpatient therapy, the patient achieved supervised independence in ADLs.