Lung Pathology: Student/Resident Case Report Poster - Lung Pathology I |

Macrolide Anti-Inflammatory Therapy in Secondary Organizing Pneumonia: A Case Series FREE TO VIEW

Hermann Simo, MD; Arjan Flora, MD; Ragheb Assaly, MD
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University of Toledo Medical Center, Toledo, OH

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

Chest. 2016;150(4_S):799A. doi:10.1016/j.chest.2016.08.895
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SESSION TITLE: Student/Resident Case Report Poster - Lung Pathology I

SESSION TYPE: Student/Resident Case Report Poster

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

INTRODUCTION: Organizing pneumonia (OP) is a diffuse interstitial lung disease with histopathologic proliferation of granulation tissue extending from the alveoli and alveolar ducts to the bronchioles due to alveolar epithelial injury. The inflammatory response of idiopathic or known secondary causes result in the leakage of plasma proteins leading to fibroblast recruitment and fibrin formation. Although there have been no randomized controlled trials, corticosteroid therapy has been the mainstay therapy for persistent and progressive disease. Over the last several years, several case reports and case series have shown that the immunomodulatory properties of macrolide antibiotics provide an alternative to long term corticosteroids in mild, stable disease or as an adjuvant therapy in persistent and progressive disease.

CASE PRESENTATION: We present three patients with OP of differing etiologies successfully treated with macrolide monotherapy or as an adjuvant to glucocorticoid therapy: 1) A 78 year old Caucasian female with autoimmune related OP secondary to primary biliary cirrhosis, 2) A 54 year old African American male with OP secondary to Cryptococcus neoformans infection, and 3) A 77 year old Caucasian male with recurrent COP despite glucocorticoid therapy.

DISCUSSION: Most of the literature documenting macrolide therapy in cryptogenic organzing pneumonia (COP) in which the causative agent is unknown. We have demonstrated that macrolide therapy can be extended to multiple differing etiologies of organizing pneumonia.

CONCLUSIONS: This case series reinforces the potential of the anti-inflammatory properties of macrolide antibiotics and demonstrates their broadened role in the treatment of all causes of OP.

Reference #1: Stover DE, Mangino D. Macrolides: a treatment alternative for bronchiolitis obliterans organizing pneumonia? Chest. 2005 Nov;128(5):3611-7.

Reference #2: Pathak V, Kuhn JM, Durham C, Funkhouser WK, Henke DC. Macrolide use leads to clinical and radiological improvement in patients with cryptogenic organizing pneumonia. Ann Am Thorac Soc. 2014 Jan;11(1):87-91. doi: 10.1513/AnnalsATS.201308-261CR.

Reference #3: Ichikawa Y, Ninomiya H, Katsuki M, Hotta M, Tanaka M and Oizumi K: Low-dose/long-term erythromycin for treatment of bronchiolitis obliterans organizing pneumonia (BOOP). Kurume Med J. 40:65-67. 1993.

DISCLOSURE: The following authors have nothing to disclose: Hermann Simo, Arjan Flora, Ragheb Assaly

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