Diffuse Lung Disease |

Unusual Radiographic Presentation of Bronchiolitis Obliterans Organizing Pneumonia (BOOP) Associated With Chlamydia pneumoniae Infection FREE TO VIEW

Karyna Neyra, MD; Abdul Rahman, MD; Zaza Cohen, MD; Justin Pi, MD
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Hackensack UMC Mountainside, Montclair, NJ

Chest. 2015;148(4_MeetingAbstracts):411A. doi:10.1378/chest.2230139
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SESSION TITLE: Diffuse Lung Disease Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: BOOP is a type of diffuse interstitial lung disease characterized by intraluminal fibrosis involving the alveolar ducts and alveoli with or without bronchiolar intraluminal polyps. BOOP can be idiopathic or associated with infections, collagen vascular diseases, drugs, malignancies or radiation. We report a case of BOOP associated with pulmonary chlamydial infection and with unique radiological features.

CASE PRESENTATION: A 53 year old woman was hospitalized for worsening dyspnea and productive cough. She was up-to-date on influenza vaccinations and had a 30-pack-year smoking history. She denied recent travel or contact with animals. Exam was remarkable for tachypnea and bilateral wheezing. Chest radiograph showed bilateral pulmonary infiltrates. A computerized tomography (CT) scan of the chest showed consolidation in the left lower lobe, emphysematous changes in the apices, and extensive "tree-in-bud opacities" sparing the upper lobes with reticulonodular opacities. Serologic tests for influenza, Legionella, Mycoplasma and Streptoccocus pneumoniae were negative, but positive for C. pneumoniae with a titer of 1:320. Bronchoscopy was unremarkable. After 10 days of Azithromycin, there was no clinical or radiographic improvement. An open lung biopsy showed intraluminal fibrosis of the distal airspaces compatible with BOOP. The patient was discharged on oral prednisone (1mg/kg/d), tapered over 3 months. On follow-up, she reported resolution of symptoms. A repeat CT of chest showed significant improvement.

DISCUSSION: BOOP is most commonly an idiopathic process, but association with a wide variety of infections has been described. To the best of our knowledge, there are only two other cases of BOOP related to acute C. pneumoniae infection. An open lung biopsy is the preferred diagnostic method. In our case, atypical radiographic findings and non-response to antibiotics prompted the additional workup. The diagnosis of C. pneumoniae infection on the grounds of serologic testing has its own limitations, but appeared to be the only contributing factor.

CONCLUSIONS: Our case strengthens the association between BOOP and C. pneumoniae. BOOP can follow all types of pneumonia and it should be considered in cases of poor symptomatic improvement and unusual radiographic findings.

Reference #1: Sara A, Hamdan A, Hanaa B, Nawaz KA. Bronchiolitis obliterans organizing pneumonia: Pathogenesis, clinical features, imaging and therapy review. Annals of Thoracic Medicine 2008; 3(2):67-75.

Reference #2: Diehl JL, Gisselbrecht M, Meyer G, Israel-Biet D, Sors H. Bronchiolitis organizing pneumonia associated with chlamydial infection. Eur Respir J 1996; 9: 1320-1322.

Reference #3: Case record of the Massachusetts general hospital. N Engl J Med 1990; 323: 1546-1555.

DISCLOSURE: The following authors have nothing to disclose: Karyna Neyra, Abdul Rahman, Zaza Cohen, Justin Pi

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