SESSION TITLE: Cancer Case Report Posters II
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM
INTRODUCTION: Organizing Pneumonia is a rare immune disorder characterized by granulation tissue that obstructs small bronchioles and extends into the distal alveolar ducts and alveoli. Though many causes have been described in literature, its association with lymphoma is rare.
CASE PRESENTATION: 82-year-old male with history of hypertension, hyperlipidemia came to the emergency room for atypical chest pain, dyspnea and non-productive cough for few months. He denied fever, weight loss or night sweats. Lab results and cardiac work up were unremarkable. Chest X ray showed right upper lobe air space disease, and a small pleural effusion. CT scan revealed multiple pulmonary nodular opacities. Transthoracic lung biopsy was done which showed benign lung parenchyma with sparse small lymphocytic infiltrate. Patient was discharged from the hospital and CT scan was repeated 6 weeks later. It showed progression of pleural effusion and lung opacities, without significant adenopathy. Biopsy via video assisted thoracoscopy was performed, and pathology showed elements of organizing pneumonia and lymphoplasmacytic infiltrates. Flow cytometry showed polyclonal CD5 + cells (B cells). Bone marrow biopsy showed minimal involvement. Patient was started on oral Prednisone for treatment of organizing pneumonia and lymphoma. Very god clinical and radiological response was seen in 4 weeks. Patient is currently on tapering dose of steroids, and is doing much better.
DISCUSSION: Cryptogenic organizing pneumonia (COP) or bronchiolitis obliterans with organizing pneumonia (BOOP) is an inflammatory lung disease with distinctive clinical, radiological and pathological features. The onset of symptoms is usually subacute with fever, nonproductive cough, malaise, anorexia, and weight loss (1). Often patients may have a non-resolving pneumonia, or get admitted with recurrent pneumonias in the same location. Organizing pneumonia may occur in association with collagen vascular disease, inflammatory bowel disease, lower respiratory tract infections, HIV infection, toxic fume inhalation, chemotherapy, malignancy, post transplant, or a reaction to pharmacologic agents. If no cause is found, it is known as cryptogenic organizing pneumonia (1). Biopsy is required to confirm the diagnosis, but often patients are empirically treated with steroids, and a good response suggests the diagnosis. Histology reveals patchy severe inflammatory response with granulation tissue obstructing the respiratory bronchioles, alveolar ducts and alveoli. Despite the severe inflammatory response, alveolar architecture is preserved. Corticosteroids remain the cornerstone of therapy, though some cases resolve on their own. The majority of patients with COP show clinical and radiological recovery in days to few weeks (2). Approximately 30% of the patients experience relapses upon withdrawal of treatment. Very few cases of organizing pneumonia in association with lymphoma have been described in the literature. Our patient was one of them, and oral steroids have benefitted him for both the diagnosis.
CONCLUSIONS: Organizing Pneumonia is an important treatable inflammatory lung disease. Radiological appearance can be suggestive, but biopsy is required for diagnosis. Corticosteroids remain the treatment of choice.
Reference #1: Cordier JF. Organising pneumonia. Thorax. 2000;55(4):318-328.
Reference #2: Epler GR. Bronchiolitis Obliterans Organizing Pneumonia. Arch Intern Med. 2001;161(2):158-164. doi:10.1001/archinte.161.2.158.
DISCLOSURE: The following authors have nothing to disclose: Vishesh Paul, Jay Lipshitz, Michael Bergman
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