General Hospital of Tianjin University, Tianjin, China
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Noninfectious “Pneumonia”
SESSION TYPE: Case Report Slide
PRESENTED ON: Sunday, April 17, 2016 at 01:00 PM - 02:00 PM
INTRODUCTION: Acute Fibrinous and Organizing Pneumonia (AFOP) was first described by Beasely et al. in 2002 as a distinct pattern of lung injury with histological analogy to diffuse alveolar damage, organizing pneumonia and eosinophilic pneumonia. It has been described in all age groups with numerous associations including connective tissue and autoimmune diseases, drugs, occupational and environmental exposures, and less commonly infectious agents. Occasionally, no cause has been found .
CASE PRESENTATION: A 50 year old female presenting with fever, cough with small amount of white sputum and gradually worsening dyspnea was admitted to this hospital. Chest CT scan showed bilateral multiple nodules and patchy infiltrates. Treatment including anti-bacterial drugs was initiated. but no improvement was observed. The dyspnea deteriorated and repeated chest CT showed an increase of the patchy infiltrates (Figure 1). Lung biopsy was performed. Lymphocyte and plasma cell infiltration and the presence of intra—alveolar fibrin in the form of fibrin“balls” (organization) within the alveolar spaces. No neutrophil and eosinophil infiltration was detected (Figure 1) ．The finding Was consistent with AFOP Corticosteroid therapy was started and the patient died of Respiratory failure, lately.
DISCUSSION: AFOP has been reported in all age groups with an average age of 62 years originally described by Beasely et al. Males are affected more commonly . The most common symptom is shortness of breath which may be accompanied by cough, fever, hemoptysis and other constitutional symptoms . A sub acute variety, which does not progress to respiratory failure and has a very good prognosis. The other variant usually manifests as a fulminant respiratory failure requiring mechanical ventilation. The most common and successful has been corticosteroids. Other agents successfully used include cyclophosphamide, mycophenolate mofetil, azathioprine and mechanical ventilation .
CONCLUSIONS: The main clinical manifestations of AFOP were similar to those of acute lung injury. Diagnosis was made by lung biopsy. The optimal treatment for AFOP had not been established. Therapy with corticosteroids could be attempted.
Reference #1: 1. Beasley MB, Franks TJ, Galvin JR, Gochuico B, Travis WD. Acute fibrinous and organizing pneumonia: a histological pattern of lung injury and possible variant of diffuse alveolar damage. Arch Pathol Lab Med. 2002;126:1064-70
Reference #2: 2. Tzouvelekis A, Koutsopoulos A, Oikonomou A, Froudarakis M, Zarogoulidis P, Steiropoulos P, et al. Acute fibrinous and organizing pneumonia: a case report and review of the literature. J Med Case Reports. 2009;3:74
Reference #3: 3. López-Cuenca S, Morales-García S, Martín-Hita A, Frutos-Vivar F, Fernández-Segoviano P, Esteban A. Severe acute respiratory failure secondary to acute fibrinous andorganizing pneumonia requiring mechanical ventilation: a case report and literature review. Respir Care. 2012;57:1337-41
DISCLOSURE: The following authors have nothing to disclose: Zhang Jinbang
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