PURPOSE: Acute Fibrinous and Organizing Pneumonia (AFOP) is an unusual variant of acute lung injury first described by Beasley, et. al. Four patients at our lung transplant center developed AFOP after undergoing lung transplantation for different pre-lung transplant indications. All were heavily immunesuppresed as part of their post-lung transplant treatment when this histologic abnormality was found, which is of particular interest as immune suppression has been suggested as a therapy for this variant of lung injury (Bhatti, et. al.).
METHODS: The clinical histories of four lung transplant patients at our institution who were diagnosed with AFOP were reviewed and compared to one another as well as to those previously described in the literature.
RESULTS: We found that our patients presented with similar symptoms to those initially described by Beasley, et. al.,including cough, dyspnea, weakness and malaise. Our patients were symptomatic for about 6 weeks prior to diagnosis of AFOP, with the exception of our final case who presented on day 2 of her illness and had diagnostic biopsies performed on that day. They had radiographic findings consistent with those previously described (Beasley, et.al.). We found that this clinical entity could occur in post-transplant patients as late as 7 years post-transplant. Two cases were preceded by documented stenotrophomonas infections.
CONCLUSION: We found AFOP occuring in lung transplant patients, which has not been previously reported. Prior studies have demonstrated patient response to immune suppressing medications. All of our patients were heavily immune suppressed prior to their development of pathologic evidence of AFOP. All patients were offered steroid bursts, but only one patient made a full recovery after the diagnosis of AFOP was made.
CLINICAL IMPLICATIONS: Our findings reveal that AFOP is a clinical entity that can occur post-lung transplant and should be suspected when patients present with dyspnea, cough, weakness and malaise. While the current treatment of this rare entity of acute lung injury is in question, we hope that with more cases identified the appropriate treatment can be identified.
DISCLOSURE: Jennifer Bierach, No Financial Disclosure Information; No Product/Research Disclosure Information