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Huo JP, Liu C, Jin BB, Duan FX, Mei SH, Li XG, Zhao ZG. Cryptogenic organizing pneumonia masquerading as lung carcinoma: A case report and review of the literature. Exp Ther Med 2018; 15:39-46. [PMID: 29399056 PMCID: PMC5769272 DOI: 10.3892/etm.2017.5393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 04/21/2017] [Indexed: 01/14/2023] Open
Abstract
Cryptogenic organizing pneumonia (COP) is a rare pulmonary disorder of unknown etiology. COP with hemoptysis as the primary presenting symptom has rarely been reported. The present study reported a case of COP that resembled lung carcinoma with hemoptysis as the only clinical symptom. The patient recovered well following thoracoscope surgery. A literature review of 119 COP cases between 1995 and 2015 was presented. Cough, fever and dyspnea were the most common clinical manifestations. The most common imaging manifestations were multiple or single consolidation, lung nodules, migratory sign, reversed halo sign, and multiple ground-glass opacity. A total of 3 cases exhibited COP accompanied by lung cancer. Glucocorticoids were effective for the majority of cases and invasive surgeries were implemented in most cases. The majority of cases recovered or relieved, and the prognosis of COP was relatively good. COP was easily confused with lung tumor and it is necessary to make differential diagnosis between COP and lung cancer. Invasive surgery should be avoided when possible to avoid or reduce patient trauma.
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Affiliation(s)
- Ji-Ping Huo
- Department of Pharmacy, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
| | - Cui Liu
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Bei-Bei Jin
- Department of Respiratory Medicine, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
| | - Feng-Xia Duan
- Department of Ultrasonography, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
| | - Sheng-Hui Mei
- Department of Pharmacy, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
| | - Xin-Gang Li
- Department of Pharmacy, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
| | - Zhi-Gang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
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Kinoshita S, Aoki T, Takahashi H, Oki H, Hayashida Y, Saito K, Tanaka Y, Korogi Y. Thin-section chest CT findings in polymyalgia rheumatica: a comparison between with and without rheumatoid arthritis. Clin Imaging 2016; 40:382-5. [PMID: 27133672 DOI: 10.1016/j.clinimag.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/22/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
We retrospectively compared the thin-section chest computed tomography (CT) findings between 25 patients of polymyalgia rheumatica (PMR) with rheumatoid arthritis (RA) and 29 patients of PMR without RA. PMR patients showed high-frequency CT abnormalities (68.5%) regardless of the association with RA. Ground-glass opacity (56% vs. 24%), traction bronchiectasis (44% vs. 3%), architectural distortion (32% vs. 0%), centrilobular nodules (32% vs. 7%), and honeycombing (20% vs. 0%) were significantly more common in the PMR with RA group than in the PMR without RA group (P<.01). PMR patients with RA have more increased prevalence of chest CT abnormalities than those without RA.
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Affiliation(s)
- Shunsuke Kinoshita
- Department of Radiology, University of Occupational and Environmental, Health School of Medicine
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental, Health School of Medicine.
| | - Hiroyuki Takahashi
- Department of Radiology, University of Occupational and Environmental, Health School of Medicine
| | - Hodaka Oki
- Department of Radiology, University of Occupational and Environmental, Health School of Medicine
| | - Yoshiko Hayashida
- Department of Radiology, University of Occupational and Environmental, Health School of Medicine
| | - Kazuyoshi Saito
- First Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental, Health School of Medicine
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Gueta I, Shoenfeld Y, Orbach H. Intravenous immune globulins (IVIg) treatment for organizing pneumonia in a selective IgG immune deficiency state. Immunol Res 2015; 60:165-9. [PMID: 25391610 DOI: 10.1007/s12026-014-8571-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe herein a 61-year-old woman who presented with fever, night sweats and cough. The diagnosis of pneumonia was established, but with symptom recurrence following antibiotic therapy, further diagnostics were performed. Biopsy via bronchoscopy revealed cryptogenic organizing pneumonia, and later on follow-up, a selective IgG immune deficiency was also diagnosed. Initial treatment of high-dose glucocorticoid therapy induced remission, but with dose reduction recurrence was observed. Intravenous immune globulin treatment was initiated and induced a successful clinical and radiological remission. Few cases of cryptogenic organizing pneumonia and hypogammaglobulinemia have been reported. To our knowledge, this is the fourth case described of cryptogenic organizing pneumonia with a hypogammaglobulinemia state and the first reported case of a selective immune deficiency state treated successfully with intravenous immune globulins.
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Affiliation(s)
- Itai Gueta
- Department of Medicine B, Wolfson Medical Center, Holon, Israel
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Marigliano B, Soriano A, Margiotta D, Vadacca M, Afeltra A. Lung involvement in connective tissue diseases: a comprehensive review and a focus on rheumatoid arthritis. Autoimmun Rev 2013; 12:1076-84. [PMID: 23684699 DOI: 10.1016/j.autrev.2013.05.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/03/2013] [Indexed: 12/20/2022]
Abstract
The lungs are frequently involved in Connective Tissue Diseases (CTDs). Interstitial lung disease (ILD) is one of the most common pleuropulmonary manifestations that affects prognosis significantly. In practice, rheumatologists and other physicians tend to underestimate the impact of CTD-ILDs and diagnose respiratory impairment when it has reached an irreversible fibrotic stage. Early investigation, through clinical evidence, imaging and - in certain cases - lung biopsy, is therefore warranted in order to detect a possible ILD at a reversible initial inflammatory stage. In this review, we focus on lung injury during CTDs, with particular attention to ILDs, and examine their prevalence, clinical manifestations and histological patterns, as well as therapeutic approaches and known complications till date. Although several therapeutic agents have been approved, the best treatment is still not certain and additional trials are required, which demand more knowledge of pulmonary involvement in CTDs. Our central aim is therefore to document the impact that lung damage has on CTDs. We will mainly focus on Rheumatoid Arthritis (RA), which - unlike other rheumatic disorders - resembles Idiopathic Pulmonary Fibrosis (IPF) in numerous aspects.
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Affiliation(s)
- Benedetta Marigliano
- Department of Clinical Medicine and Rheumatology, University Campus Bio-Medico of Rome, Italy
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Organizing pneumonia: Manifestation peculiarities, causes, and outcomes. Open Med (Wars) 2011. [DOI: 10.2478/s11536-011-0025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
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Yoo JW, Song JW, Jang SJ, Lee CK, Kim MY, Lee HK, Jegal Y, Kim DS. Comparison between cryptogenic organizing pneumonia and connective tissue disease-related organizing pneumonia. Rheumatology (Oxford) 2010; 50:932-8. [DOI: 10.1093/rheumatology/keq410] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN. Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review. Ann Thorac Med 2010; 3:67-75. [PMID: 19561910 PMCID: PMC2700454 DOI: 10.4103/1817-1737.39641] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 01/13/2008] [Indexed: 12/20/2022] Open
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) was first described in the early 1980s as a clinicopathologic syndrome characterized symptomatically by subacute or chronic respiratory illness and histopathologically by the presence of granulation tissue in the bronchiolar lumen, alveolar ducts and some alveoli, associated with a variable degree of interstitial and airspace infiltration by mononuclear cells and foamy macrophages. Persons of all ages can be affected. Dry cough and shortness of breath of 2 weeks to 2 months in duration usually characterizes BOOP. Symptoms persist despite antibiotic therapy. On imaging, air space consolidation can be indistinguishable from chronic eosinophilic pneumonia (CEP), interstitial pneumonitis (acute, nonspecific and usual interstitial pneumonitis, neoplasm, inflammation and infection). The definitive diagnosis is achieved by tissue biopsy. Patients with BOOP respond favorably to treatment with steroids.
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Affiliation(s)
- Sara Al-Ghanem
- Department of Radiology, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Affiliation(s)
- Krista A. White
- Krista A. White currently works as a clinical faculty member at the Lancaster General College of Nursing and Health Sciences in Lancaster, Pa. She has 20 years of critical care experience in cardiothoracic surgery and intermediate intensive care
| | - Lisa A. Ruth-Sahd
- Lisa A. Ruth-Sahd, a nurse educator and a winner of a Nightingale Award of Pennsylvania, is currently an associate professor at York College of Pennsylvania, York, Pa. She also works part-time as a staff nurse in the intensive care unit at Lancaster General Hospital, Lancaster, Pa. She has 23 years of experience in the emergency department and intensive care
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Bravo Soberón A, Torres Sánchez MI, García Río F, Sánchez Almaraz C, Parrón Pajares M, Pardo Rodríguez M. [High-resolution computed tomography patterns of organizing pneumonia]. Arch Bronconeumol 2007; 42:413-6. [PMID: 16948996 DOI: 10.1016/s1579-2129(06)60557-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Organizing pneumonia is an uncommon lung disease with a wide variety of radiologic findings, few of which have been discussed in the literature. We performed high resolution computed tomography on 34 patients with a histological diagnosis of organizing pneumonia and studied the images they presented. Twenty-five of the cases were idiopathic and 9 secondary. The findings observed were parenchymal consolidation (76%), ground glass opacity (59%), bronchial dilatation (53%), centrilobular nodules (35%), septal thickening (23%), halo sign (15%), and reversed halo sign (12%). Secondary cases presented more findings of septal thickening and fewer complete remissions.
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Neild GH, Rodriguez-Justo M, Wall C, Connolly JO. Hyper-IgG4 disease: report and characterisation of a new disease. BMC Med 2006; 4:23. [PMID: 17026742 PMCID: PMC1618394 DOI: 10.1186/1741-7015-4-23] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 10/06/2006] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We highlight a chronic inflammatory disease we call 'hyper-IgG4 disease', which has many synonyms depending on the organ involved, the country of origin and the year of the report. It is characterized histologically by a lymphoplasmacytic inflammation with IgG4-positive cells and exuberant fibrosis, which leaves dense fibrosis on resolution. A typical example is idiopathic retroperitoneal fibrosis, but the initial report in 2001 was of sclerosing pancreatitis. METHODS We report an index case with fever and severe systemic disease. We have also reviewed the histology of 11 further patients with idiopathic retroperitoneal fibrosis for evidence of IgG4-expressing plasma cells, and examined a wide range of other inflammatory conditions and fibrotic diseases as organ-specific controls. We have reviewed the published literature for disease associations with idiopathic, systemic fibrosing conditions and the synonyms: pseudotumour, myofibroblastic tumour, plasma cell granuloma, systemic fibrosis, xanthofibrogranulomatosis, and multifocal fibrosclerosis. RESULTS Histology from all 12 patients showed, to varying degrees, fibrosis, intense inflammatory cell infiltration with lymphocytes, plasma cells, scattered neutrophils, and sometimes eosinophilic aggregates, with venulitis and obliterative arteritis. The majority of lymphocytes were T cells that expressed CD8 and CD4, with scattered B-cell-rich small lymphoid follicles. In all cases, there was a significant increase in IgG4-positive plasma cells compared with controls. In two cases, biopsies before and after steroid treatment were available, and only scattered plasma cells were seen after treatment, none of them expressing IgG4. Review of the literature shows that although pathology commonly appears confined to one organ, patients can have systemic symptoms and fever. In the active period, there is an acute phase response with a high serum concentration of IgG, and during this phase, there is a rapid clinical response to glucocorticoid steroid treatment. CONCLUSION We believe that hyper-IgG4 disease is an important condition to recognise, as the diagnosis can be readily verified and the outcome with treatment is very good.
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Affiliation(s)
- Guy H Neild
- UCL Centre for Nephrology, Royal Free Hospital, London NW3 2QG, UK
- Institute of Urology and Nephrology, Middlesex Hospital, London W1T 3AA, UK
| | - Manuel Rodriguez-Justo
- Department of Histopathology, Royal Free and University College Medical School, University College Hospital, Rockefeller Building, London WC1E 6JJ, UK
| | - Catherine Wall
- UCL Centre for Nephrology, Royal Free Hospital, London NW3 2QG, UK
| | - John O Connolly
- UCL Centre for Nephrology, Royal Free Hospital, London NW3 2QG, UK
- Institute of Urology and Nephrology, Middlesex Hospital, London W1T 3AA, UK
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Bravo Soberón A, Torres Sánchez MI, García Río F, Sánchez Almaraz C, Parrón Pajares M, Pardo Rodríguez M. Patrones de presentación de la neumonía organizada mediante tomografía computarizada de alta resolución. Arch Bronconeumol 2006. [DOI: 10.1157/13091652] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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12
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Abstract
Cryptogenic organizing pneumonia is a rare, distinct disorder that is sufficiently different from the other diseases in the group of idiopathic interstitial pneumonias to be designated as a separate entity. In its most typical presentation, it is characterized by dyspnea and cough, with multiple patchy alveolar opacities on pulmonary imaging. Definite diagnosis is obtained by the finding of buds of granulation tissue in the distal airspaces at lung biopsy. No cause (as infection, drug reaction, or associated disease as connective tissue disease) is found. Corticosteroid treatment is rapidly effective, but relapses are common on reducing or stopping treatment.
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Affiliation(s)
- Jean-François Cordier
- Department of Respiratory Medicine and Center for Orphan Lung Diseases, Louis Pradel Hospital, Claude Bernard University, 28 Avenue Doyen Lépine, 69677 Lyon (Bron), France.
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Kato T, Ubara Y, Sawa N, Tagami T, Katori H, Takemoto F, Hara S, Takaichi K. An abrupt onset of seropositive polyarthritis with prominent distal tenosynovitis concomitant with bronochiolitis obliterans organizing pneumonia (BOOP): consideration of the relationship with RS3PE syndrome. Intern Med 2004; 43:143-7. [PMID: 15005259 DOI: 10.2169/internalmedicine.43.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 64-year-old Japanese woman with a two-week history of polyarthralgia and persistent cough was diagnosed as seropositive polyarthritis and fulfilled the criteria of early rheumatoid arthritis (RA). In addition, inflammatory pitting edema of the distal extremities was apparent, suggestive of the remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. A number of investigations including hand MRI, bone scintigraphy and HLA typing supported a diagnosis of RS3PE syndrome rather than RA. Chest computed tomography revealed concomitant evidence of bronchiolitis obliterans organizing pneumonia (BOOP). Treatment with 30 mg of prednisolone daily immediately ameliorated the polyarthritis and the BOOP. Seropositive polyarthritis with distal pitting edema may be categorized as both RA and the RS3PE syndrome.
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Affiliation(s)
- Takashi Kato
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Takatsu-ku, Kawasaki, Kanagawa 213-8587
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DeAngelo AJ, Ouellette D. Bronchiolitis obliterans organizing pneumonia in an orthotopic liver transplant patient. Transplantation 2002; 73:544-6. [PMID: 11889426 DOI: 10.1097/00007890-200202270-00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 67-year-old woman was hospitalized for progressive dyspnea on exertion. She had undergone orthotopic liver transplantation (OLT) 15 months before admission. Posttransplant therapy consisted of tacrolimus, trimethoprim/sulfamethoxazole, and prednisone (the latter two were discontinued after 1 year). Physical examination revealed fine bibasilar crackles. High-resolution chest CT demonstrated bilateral, diffuse, interstitial infiltrates. Symptoms persisted on i.v. antibiotics and bronchoscopy was performed demonstrating patchy fibroplastic plugs within air spaces consistent with bronchiolitis obliterans organizing pneumonia (BOOP). Prednisone was initiated and the patient had an uneventful recovery. BOOP was initially described as an idiopathic disease process with clinical, radiographic, pathological, and prognostic features distinguishing it from bronchiolitis obliterans and idiopathic pulmonary fibrosis. BOOP has been recognized as a complication of lung and bone marrow transplantation, but the mechanism is unknown. We report a case of BOOP after OLT to highlight the risk in all transplant patients as well as the protective effect of posttransplant prednisone.
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Affiliation(s)
- Alan J DeAngelo
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
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Affiliation(s)
- J F Cordier
- Service de Pneumologie, Hôpital Louis Pradel, Université Claude Bernard, 69394 Lyon Cedex, France
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