SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters I
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Organizing pneumonia (OP) has various etiologies and lung cancer is one of them. OP generally occurs near the vicinity of tumor, with or without airway obstruction. We present an unusual case of OP presenting as cough and bilateral lung opacities as a result of carcinoid tumor, which resolved completely with bronchoscopic partial relief of obstruction without the need for steroid therapy.
CASE PRESENTATION: A 48-year-old woman, never smoker, with past history of Lyme disease presented with non-resolving cough of six-month duration and progressive dyspnea on exertion. She was on chronic therapy with azithromycin, minocycline and plaquenil for her Lyme disease. Her prior work up included autoimmune serologies for connective tissue disease, which were negative, and CT scan of the chest revealed a 16 mm lingular nodule. PFT’s revealed normal expiratory flows and lung capacity. A repeat CT scan of the chest was performed that revealed increase in size of lingular nodule, and associated bilateral lung parenchymal opacities (see images), some with reverse halo sign. Patient subsequently underwent diagnostic and therapeutic bronchoscopy and was found to have partially obstructing lesion, with intrinsic and extrinsic component, in the inferior lingular sub-segment of the left upper lobe. Transbronchial biopsies of the tumor and lung parenchyma were performed, which showed carcinoid tumor and OP respectively. Mechanical debulking of endobronchial tumor was performed using large (2.8 mm) biopsy forceps along with balloon dilation and therapeutic aspiration. A repeat CT scan of the chest was performed a month later; this revealed near complete resolution of lung opacities (see images). Subsequently, she underwent left thoracotomy with lingulectomy for complete resection of the tumor and has complete resolution of her initial presenting symptoms.
DISCUSSION: OP is an inflammatory disease, characterized by intra-alveolar buds of intermixed myofibroblasts and connective tissue, which is completely reversible despite development of intra-alveolar fibrosis. Treatment of primary etiology in secondary OP and steroid therapy in cryptogenic OP results in rapid resolution. Our patient is unique in many ways as she developed OP while on macrolide therapy, even though this has been used in treatment of mild to moderate disease and some cases refractory to steroid therapy. Further, she had near resolution with partial relief of obstruction without need for steroid therapy. To our knowledge this has not been reported previously.
CONCLUSIONS: OP can present as a result of tumor causing luminal obstruction. Relief of obstruction is warranted prior to consideration of steroid therapy.
Reference #1: Cryptogenic organising pneumonia, J.F Cordier; European Respiratory Journal 2006:28:422-446
Reference #2: Organising pneumonia J.F Cordier, Thorax 2000;55:318-328
DISCLOSURE: The following authors have nothing to disclose: Karan Mahajan, Allen Burke, Whitney Burrows, Ashutosh Sachdeva
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