SESSION TITLE: Lung Pathology Case Report Posters
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Cryptogenic organizing pneumonia is an organizing pneumonia without a known etiology such as infection or vasculitis. The primary injury is within the alveolar wall. It is defined by a clinical and radiographic pattern with certain histological characteristics.
CASE PRESENTATION: A 26 year-old-male presented to the emergency department with a complaint of blurry vision and back pain. He was found to have an elevated blood pressure. A CT of the chest, abdomen, and pelvis was ordered to rule out aortic dissection. The only significant finding was centrally located bilateral ground glass opacities with sparing of the pleura. The patient reported progressive dyspnea with exertion one week prior to presentation with occasional brownish sputum production and wheeze. He described chills without fever. There were no sick contacts, travel outside North America, or pet exposure. He did report smoking marijuana two to three times per day. Given his respiratory symptoms, hypertension and radiographic findings, an extensive workup for autoimmune, and vasculitis etiology was obtained; including ANA, C-ANCA, P-ANCA, SSA, SSB, anti-DS DNA, and rheumatoid factor which were all negative. An infectious workup was non-diagnostic. He subsequently underwent flexible bronchoscopy with transbronchial biopsy. The pathologic specimens were significant for cryptogenic organizing pneumonia. Given the extensive negative workup, this is most likely from marijuana. He was treated conservatively and did not require steroids or antibiotic treatment. He was advised and counseled regarding the dangers of smoking marijuana. A follow up chest radiograph four and 12 months after the diagnosis demonstrated complete resolution of the bilateral airspace opacities. Unfortunately he did not follow up for pulmonary function testing.
DISCUSSION: This case demonstrates that the diagnosis of cryptogenic organizing pneumonia may be illusive and mistaken for other entities. The diagnosis frequently requires bronchoscopy with biopsies. Histologically, the lesions demonstrate excessive proliferation of granulation tissue within the alveolar ducts and alveoli. Treatment depends on the severity of the disease, ranging from antibiotics, steroids, and at times immunosuppressive medications.
CONCLUSIONS: While the pathogenesis remains unclear of the cellular injury, other etiologies must be sought after. To date there has been no report of cryptogenic organizing pneumonia secondary to marijuana use.
Reference #1: Eur Respir J. (2006) 422-446
Reference #2: Clin Chest Med 25 (2004) 727-73
DISCLOSURE: The following authors have nothing to disclose: Michael Burton, Prabhat Sinha
No Product/Research Disclosure Information