Lung Pathology: Fellow Case Report Poster - Lung Pathology |

Acute Fibrinous and Organizing Pneumonia Following Hematopoietic Stem Cell Transplantation Responsive to Corticosteroid Therapy FREE TO VIEW

Derek Hansen, MD; Melissa Brents, MD; Avani Mehta, MD
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University of Mississippi Medical Center, Jackson, MS

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):771A. doi:10.1016/j.chest.2016.08.867
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SESSION TITLE: Fellow Case Report Poster - Lung Pathology

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: We describe a case of a 30-year-old female with acute fibrinous and organizing pneumonia (AFOP) following allogeneic hematopoietic stem cell transplant (HSCT) that responded well to corticosteroid therapy.

CASE PRESENTATION: A 30-year-old female presented with a two-week history of productive cough, low-grade fevers, and fatigue. She has a history of T-cell acute lymphoblastic leukemia and underwent allogeneic HSCT about fifteen months prior that, was complicated by engraftment syndrome and graft vs. host disease (GVHD) of the skin. She was on immunosuppressant therapy. Chest x-ray revealed bilateral patchy opacities. She decompensated despite initial broad-spectrum antibiotics and was intubated for hypoxemic respiratory failure. Computed tomography (CT) of the chest showed bilateral patchy ground glass opacities. Bronchoscopy was performed in light of her history and transbronchial biopsies showed intra-alveolar fibrin balls consistent with AFOP. The patient was treated with pulse dose steroids and then continued on weight-based Prednisone therapy. Her infiltrates cleared, she was successfully extubated, and able to be discharged home.

DISCUSSION: Acute Fibrinous and Organizing Pneumonia is a rare interstitial pneumonia pattern characterized by intra-alveolar fibrin deposition. Beasly et al first described it in 2002 as an unusual type of acute lung injury. In 2009, the first case of AFOP following HSCT was reported; unfortunately that patient did not survive. We report a case, appearing to be the first per our literature search, of successfully treated AFOP following HSCT. At the present time, no specific treatment exists, but patients may benefit from corticosteroid therapy, as appeared to happen in our case.

CONCLUSIONS: Non-infectious pulmonary complications are major causes of morbidity and mortality after allogeneic HSCT. Although uncommon, AFOP warrants consideration in the differential diagnosis of non-infectious pulmonary complications following transplantation, and may even be a manifestation of GVHD.

Reference #1: M.B Beasley, T. J. Franks, J. R. Galvin, B. Gochuico, W. D. Travis. Acute Fibrinous and Organizing Pneumonia: a histological pattern of lung injury and possible variant of Diffuse Alveolar Damage. Arch Pathol Lab Med, 126 (9) (2002), pp. 1064-1070.

DISCLOSURE: The following authors have nothing to disclose: Derek Hansen, Melissa Brents, Avani Mehta

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