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Choudhary N, Gupta V, Mishra P, Banerjee M. Radiological presentation of transient perivascular inflammation of carotid artery syndrome in a patient with myelodysplasia. Neuroradiol J 2024; 37:126-127. [PMID: 36951500 PMCID: PMC10863575 DOI: 10.1177/19714009231166079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Transient Perivascular Inflammation of Carotid artery syndrome (TIPIC syndrome) is a non-specific inflammatory thickening of the carotid artery. The exact etiology of this syndrome is poorly understood. We will describe the radiological findings of a rare case of TIPIC syndrome in a patient with myelodysplastic syndrome and discuss the potential pathophysiological mechanisms.
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Affiliation(s)
- Neha Choudhary
- Department of Radiology, Amrita Hospital, Faridabad, India
| | - Vivek Gupta
- Department of Radiology, Amrita Hospital, Faridabad, India
| | - Pravas Mishra
- Department of Hematology/Medical Oncology and BMT, Amrita Hospital, Faridabad, India
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2
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Jiang D, Chen X, Li J, Zhao L, Dai H. Case report: Corticosteroid-resistant acute fibrinous and organizing pneumonia with myelodysplastic syndrome. Front Med (Lausanne) 2023; 9:1047783. [PMID: 36714123 PMCID: PMC9877430 DOI: 10.3389/fmed.2022.1047783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Acute fibrinous and organizing pneumonia (AFOP) is a lung disease with an unusual pathological pattern. The definitive diagnosis of AFOP relies on pathological evidence of intra-alveolar fibrin exudate, lymphoplasmacytic infiltrate, and the absence of a hyaline membrane. Furthermore, its etiology is difficult to confirm, and corticosteroids are usually effective. Herein, we report the case of a young male who presented with high fever, hemocytopenia, and consolidation in both lungs. The initial misdiagnosis was community-acquired pneumonia. Subsequently, a lung biopsy revealed abundant fibrin and fibroblast exudates in the alveolar spaces, indicating AFOP. In addition, bone marrow biopsy and karyotype analysis demonstrated that the patient simultaneously had myelodysplastic syndrome (MDS) and hemophagocytic lymphohistiocytosis. In this case, the AFOP was considered secondary to MDS; however, the disease did not respond to glucocorticoid treatment or chemotherapy. Hence, AFOP should be considered in patients with underlying hematological diseases, and early identification and diagnosis are important. Furthermore, the management of patients with severe AFOP requires further investigation.
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Affiliation(s)
- Dingyuan Jiang
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Institute of Respiratory Medicine, Chinese Academy of Medicine Sciences, Beijing, China
| | - Xueying Chen
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Institute of Respiratory Medicine, Chinese Academy of Medicine Sciences, Beijing, China
| | - Jun Li
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Institute of Respiratory Medicine, Chinese Academy of Medicine Sciences, Beijing, China
| | - Ling Zhao
- Laboratory Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Huaping Dai
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Institute of Respiratory Medicine, Chinese Academy of Medicine Sciences, Beijing, China,*Correspondence: Huaping Dai ✉
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Fozza C, Murtas A, Caocci G, La Nasa G. Autoimmune disorders associated with myelodysplastic syndromes: clinical, prognostic and therapeutic implications. Leuk Res 2022; 117:106856. [PMID: 35525186 DOI: 10.1016/j.leukres.2022.106856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/29/2022]
Abstract
Around one third of patients with myelodysplastic syndromes (MDS) suffer from concomitant autoimmune disorders (AD). However the actual burden of such an association appears to be quite heterogeneous in different studies probably due to variable criteria in selecting both MDS patients and subtypes of AD. Moreover, both the prognostic implications and the potential applications of specific therapeutic approaches in this patient subgroup are still at least partially under debate. The present review will try to shed some further light on the clinical association between MDS and AD in order to better delineate its prognostic significance and to suggest potential therapeutic algorithms available for these patients.
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Affiliation(s)
- Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
| | - Andrea Murtas
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
| | - Giovanni Caocci
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
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Bizymi N, Pitsidianakis G, Ierodiakonou D, Stathakis G, Vasarmidi E, Hiraki S, Bolaki M, Karagiannis K, Fanaridis M, Liopyrakis K, Marinos L, Xilouri I, Antoniou KM, Tzanakis N. Case Report: Diagnosis of Myelodysplastic Syndrome in a 72-Year-Old Female With Interstitial Lung Disease. Front Med (Lausanne) 2021; 8:673573. [PMID: 34434942 PMCID: PMC8380831 DOI: 10.3389/fmed.2021.673573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Acute fibrinous and organizing pneumonia (AFOP) is an entity that can be secondary to various conditions leading to lung injury, such as infections, malignancies, and various autoimmune conditions or idiopathic interstitial lung disease, when no obvious underlying cause is identified. Myelodysplastic syndromes (MDS), on the other hand, are a spectrum of clonal myeloid disorders, with a higher risk of acute leukemia, characterized by ineffective bone marrow (BM) hematopoiesis and, thus, peripheral blood (PB) cytopenias. Immune deregulation is thought to take part in the pathophysiology of the disease, including abnormal T and/or B cell responses, innate immunity, and cytokine expression. In the literature, there are a few case reports of patients with MDS that have presented pulmonary infiltrates and were diagnosed as having AFOP or organizing pneumonia (OP). It is rare, though, to have isolated pulmonary infiltrates without Sweet's syndrome or even the pulmonary infiltrates to precede the diagnosis and treatment of MDS, which was our case. We present a 72-year-old female developing new lung infiltrates refractory to antibiotic treatment that responded well to corticosteroids and was histologically described as having OP. The treatment was gradually successfully switched to mycophenolate mofetil (MMF). The patient was later diagnosed with MDS. This interesting case report suggests firstly that a diagnosis of AFOP or OP should alert the clinician to search for an underlying cause including MDS and vice versa, the use of systemic steroids should not be postponed, and, finally, that MMF can successfully be used in these patients.
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Affiliation(s)
- Nikoleta Bizymi
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece.,Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | | | - Despo Ierodiakonou
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece.,Department of Primary care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Georgios Stathakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Stavroti Hiraki
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Bolaki
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | | | - Michail Fanaridis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos Liopyrakis
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Leonidas Marinos
- Department of Hemopathology, Evangelismos General Hospital, Athens, Greece
| | - Irini Xilouri
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
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Lee JH, Yum HK, Jamous F, Santos C, Campisi A, Surani S, Lococo F, Goo JM, Yoon SH. Diagnostic procedures and clinico-radiological findings of acute fibrinous and organizing pneumonia: a systematic review and pooled analysis. Eur Radiol 2021; 31:7283-7294. [PMID: 33791819 DOI: 10.1007/s00330-021-07868-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/12/2021] [Accepted: 03/11/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the clinico-radiological findings of acute fibrinous and organizing pneumonia (AFOP) in the literature according to whether a surgical or non-surgical biopsy was performed, as well as to identify prognostic predictors. METHODS We searched the Embase and OVID-MEDLINE databases to identify studies that presented CT findings of AFOP and had extractable individual patient data. We compared the clinical and CT findings of the patients depending on whether a surgical or non-surgical biopsy was performed and identified survival predictors using a multivariate logistic regression analysis. RESULTS Eighty-one patients (surgical biopsy, n = 52; non-surgical biopsy, n = 29) from 63 studies were included. The surgical biopsy group frequently experienced an acute fulminant presentation (p = .011) and dyspnea (p = .001) and less frequently had a fever (p = .006) than the non-surgical biopsy group. The surgical biopsy group had a worse prognosis than the non-surgical biopsy group in terms of mechanical ventilation and mortality (both, p = .023). For survival analysis, the patients with the predominant CT finding of patchy or mass-like air-space consolidation survived more frequently (p < .001) than those with other CT findings. For prognostic predictors, subacute indolent presentation (p = .001) and patchy or mass-like air-space consolidation on CT images (p = .002) were independently associated with good survival. CONCLUSIONS Approximately one-third of alleged AFOP cases in the literature were diagnosed via non-surgical biopsy, but those cases had different symptomatic presentations and prognosis from surgically proven AFOP. Subacute indolent presentation and patchy or mass-like air-space consolidation at the presentation on CT images indicated a good prognosis in patients with AFOP. KEY POINTS • Acute fibrinous and organizing pneumonia (AFOP) cases diagnosed via non-surgical biopsy had different symptomatic presentations and prognosis from surgically proven AFOP. • Subacute indolent presentation and patchy or mass-like air-space consolidation on CT images indicated a good prognosis in patients with acute fibrinous and organizing pneumonia.
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Affiliation(s)
- Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, South Korea
| | - Ho-Kee Yum
- Department of Internal Medicine, Seoul Paik Hospital, Inje University, Seoul, South Korea
| | - Fady Jamous
- Department of Pulmonary & Sleep Medicine, Avera Medical Group, Sioux Falls, SD, USA
| | - Cláudia Santos
- Pulmonology Service, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Alessio Campisi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Salim Surani
- Department of Medicine, University of North Texas, Denton, TX, USA.,Department of Medicine, Texas A&M University, Corpus Christi, TX, USA
| | - Filippo Lococo
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, South Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, South Korea.
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Ning YJ, Ding PS, Ke ZY, Zhang YB, Liu RY. Successful steroid treatment for acute fibrinous and organizing pneumonia: A case report. World J Clin Cases 2018; 6:1053-1058. [PMID: 30568963 PMCID: PMC6288515 DOI: 10.12998/wjcc.v6.i15.1053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Since the acute fibrinous and organizing pneumonia (AFOP) was first described by Beasley in 2002, some case reports of patients aged from 38 d to 80 years have been published worldwide, but there is still no standard therapy for this disease and the treatment methods remain controversial. Both steroid and immunosuppressive agents, such as cyclophosphamide or mycophenolate mofetil, have been reported to be effective in some studies, but with many side effects, especially in patients of advanced age.
CASE SUMMARY We herein report an 81-year-old female patient who was admitted to our hospital due to dry cough, and breathlessness for 1 mo. She was treated with broad-spectrum antibiotics and anti-fungal therapy, but without improvement in both symptoms and radiological findings, and her respiratory status worsened, and she required bed rest almost the whole day. Computed tomography-guided percutaneous needle lung biopsy was performed and histopathology examination confirmed the diagnosis of AFOP. She was then successfully treated with a steroid monotherapy, which resulted in a satisfactory clinical outcome without serious complications.
CONCLUSION We conclude that complete remission of AFOP can be achieved by steroid monotherapy in patients of advanced age.
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Affiliation(s)
- Ya-Jing Ning
- Department of Geriatric Respiratory and Critical Care, the First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Pei-Shan Ding
- Department of Geriatric Respiratory and Critical Care, the First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Zhang-Yan Ke
- Department of Geriatric Respiratory and Critical Care, the First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Yan-Bei Zhang
- Department of Geriatric Respiratory and Critical Care, the First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Rong-Yu Liu
- Department of Geriatric Respiratory and Critical Care, the First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
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Dai JH, Li H, Shen W, Miao LY, Xiao YL, Huang M, Cao MS, Wang Y, Zhu B, Meng FQ, Cai HR. Clinical and Radiological Profile of Acute Fibrinous and Organizing Pneumonia: A Retrospective Study. Chin Med J (Engl) 2016; 128:2701-6. [PMID: 26481733 PMCID: PMC4736875 DOI: 10.4103/0366-6999.167293] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Acute fibrinous and organizing pneumonia (AFOP) is a unique pathological entity with intra-alveolar fibrin in the form of “fibrin balls” and organizing pneumonia. It was divided into rare idiopathic interstitial pneumonia according to the classification notified by American Thoracic Society/European Respiratory Society in 2013. As a rare pathological entity, it is still not well known and recognized by clinicians. We reviewed the clinical features of 20 patients with AFOP diagnosed in a teaching hospital. Methods: The medical records of 20 patients with biopsy-proven diagnosis of AFOP were retrospectively reviewed. The patients’ symptoms, duration of the disease, comorbidities, clinical laboratory data, pulmonary function testing, radiographic studies, and the response to treatment were extracted and analyzed. Results: Fever was the most common symptom and was manifested in 90% of AFOP patients. For clinical laboratory findings, systematic inflammatory indicators, including C-reactive protein and erythrocyte sedimentation rate, were significantly higher than normal in AFOP patients. In accordance with this increased indicators, injured liver functions were common in AFOP patients. Inversely, AFOP patients had worse clinical conditions including anemia and hypoalbuminemia. For pulmonary function testing, AFOP patients showed the pattern of restrictive mixed with obstructive ventilation dysfunction. For high-resolution computerized tomography (HRCT) findings, the most common pattern for AFOP patients was lobar consolidation which was very similar to pneumonia. However, unlike pneumonia, AFOP patients responded well to glucocorticoids. Conclusion: Patients with AFOP manifest as acute inflammatory-like clinical laboratory parameters and lobar consolidation on HRCT, but respond well to steroid.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Hou-Rong Cai
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
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Gomes R, Padrão E, Dabó H, Soares Pires F, Mota P, Melo N, Jesus JM, Cunha R, Guimarães S, Souto Moura C, Morais A. Acute fibrinous and organizing pneumonia: A report of 13 cases in a tertiary university hospital. Medicine (Baltimore) 2016; 95:e4073. [PMID: 27399094 PMCID: PMC5058823 DOI: 10.1097/md.0000000000004073] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Acute fibrinous and organizing pneumonia (AFOP) is a rare diffuse pulmonary disease, but it is not yet known whether it is a distinct form of interstitial pneumonia or simply a reflection of a tissue sampling issue. METHODS Cross-sectional evaluation of clinical and radiological findings, treatments, and outcomes for patients with histologically confirmed AFOP at a tertiary university hospital between 2002 and 2015. RESULTS Thirteen patients (7 women, 53.8%) with a mean ± SD age of 53.5 ± 16.1 years were included. The main symptoms were fever (69.2%), cough (46.2%), and chest pain (30.8%). All patients presented a radiological pattern of consolidation and 5 (38.5%) had simultaneous ground-glass areas. Histology was obtained by computed tomography-guided transthoracic biopsy in 61.5% of cases and by surgical lung biopsy in the remaining cases. Several potential etiologic factors were identified. Eight patients (61.5%) had hematologic disorders and 3 had undergone an autologous hematopoietic cell transplant. Two (15.4%) had microbiologic isolates, 5 (38.4%) had drug-induced lung toxicity, and 2 (15.4%) were classified as having idiopathic AFOP. In addition to antibiotics and diuretics used to treat the underlying disease, the main treatment was corticosteroids, combined in some cases with immunosuppressants. Median survival was 78 months and 6 patients (46.2%) were still alive at the time of analysis. CONCLUSION Our findings for this series of patients confirm that AFOP is a nonspecific reaction to various agents with a heterogeneous clinical presentation and clinical course that seems to be influenced mainly by the severity of the underlying disorder.
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Affiliation(s)
- Rita Gomes
- Pulmonology Department, Hospital Sousa Martins, ULS-Guarda, Guarda, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Correspondence: Rita Gomes, Pulmonology Department, Hospital Sousa Martins, ULS-Guarda, Avenida Rainha D. Amélia, 6301-857 Guarda, Portugal (e-mail: )
| | - Eva Padrão
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Hans Dabó
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
| | | | - Patrícia Mota
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Natália Melo
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
| | - José Miguel Jesus
- Faculty of Medicine, University of Porto, Portugal
- Radiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Rui Cunha
- Faculty of Medicine, University of Porto, Portugal
- Radiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Susana Guimarães
- Faculty of Medicine, University of Porto, Portugal
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Conceição Souto Moura
- Faculty of Medicine, University of Porto, Portugal
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - António Morais
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
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Yamamoto M, Murata K, Kiriu T, Kouzai Y, Takamori M. Acute Fibrinous and Organizing Pneumonia with Myelodysplastic Syndrome: Corticosteroid Monotherapy Led to Successful Ventilator Weaning. Intern Med 2016; 55:3155-3159. [PMID: 27803411 PMCID: PMC5140866 DOI: 10.2169/internalmedicine.55.6864] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 62-year-old man with myelodysplastic syndrome (MDS) presented to our hospital with a high fever. Although treatment with broad-spectrum antibiotics was initiated, his respiratory status worsened to the point that he required mechanical ventilation. However, he was successfully treated with a corticosteroid without immunosuppression. Sequential transbronchial lung biopsies revealed abundant fibrin exudate in the alveolar spaces, which was subsequently replaced by fibroblasts, showing that acute fibrinous and organizing pneumonia (AFOP) gradually changes into organizing pneumonia. Our case demonstrated both the efficacy of corticosteroid-monotherapy and the histological course of AFOP.
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