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Lung Pathology |

A Rare Presentation of A Rare Disease: Rapidly Progressing Cryptogenic Organizing Pneumonia (COP)

Shahniwaz Labana, MD; Adam Hull, DO; Sandip Saha, MD; Eyoel Abebe, MD
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Wayne State University, Troy, MI


Chest. 2015;148(4_MeetingAbstracts):633A. doi:10.1378/chest.2254337
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Abstract

SESSION TITLE: Lung Pathology 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: Cryptogenic organizing pneumonia (COP) is a diffuse inflammatory interstitial lung disease that affects the bronchioles, respiratory bronchioles, alveolar ducts and alveolar walls. The incidence is only 6 to 7 cases per 100,000 hospital admissions.1 In the majority of cases, this disease solely affects the airways; however, our patient was unique with parenchymal involvement as well as a rapidly progressive course that has yet to be reported.

CASE PRESENTATION: A 51-year-old African-American male with no past medical history was admitted for progressive dyspnea and left sided pleuritic chest pain. A CT chest with contrast was performed on admission that demonstrated left lower lobe infiltrates with a mild left pleural effusion. The patient was treated for community acquired pneumonia but did not show any improvement. A repeat high resolution CT chest performed 2 days later demonstrated a large left pleural effusion. A thoracentesis was attempted; however, no fluid could be aspirated. Thoracic surgery was consulted and performed a thoracotomy which demonstrated dense fibropurulent material that was adherent to the left lung parenchyma. A complete decorticatation was performed and specimens were sent for histopathology. The patient significantly improved post-operatively and was transferred out of the ICU. Results from the histpathology demonstrated a parenchymalorganizing pneumonia with fibrosis and chronic inflammation with no identifiable organisms, findings consistent with cryptogenic pneumonia. The rapid progression of a mild left pleural effusion into extensive COP, with the addition of parenchymal involvement, illustrates a novel presentation of this already rare pathology.

DISCUSSION: The exact pathogenesis of COP is unknown; however, it is postulated to be an inflammatory response to alveolar injury resulting in leakage of plasma proteins, recruitment of fibroblasts, and fibrin formation within the alveolar lumen. This process consequently results in an airspace disease that mimics pneumonia but frequently does not respond to antibiotic therapy. Our patient is unique in that the affected portion of the lung was the parenchyma instead of the airways. Furthermore, COP tends to have an insidious onset with gradual progression of symptoms; however, our patient developed symptoms rapidly with astounding evolution of the imaging findings. If the thoracotomy had not been performed, the rapid nature of his illness may have dramatically altered the outcome.

CONCLUSIONS: COP is a rare pulmonary disease that mimics a number of pulmonary pathologies, namely pneumonia. As such, it must be considered in patients who are failing antibiotic therapy but must also be considered in the acute setting, as evidenced by our patient.

Reference #1: 1. Alasaly K1, Muller N, Ostrow DN, Champion P, FitzGerald JM, Medicine (Baltimore). 1995 Jul;74(4):201-11.Cryptogenic organizing pneumonia. A report of 25 cases and a review of the literature.

DISCLOSURE: The following authors have nothing to disclose: Shahniwaz Labana, Adam Hull, Sandip Saha, Eyoel Abebe

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