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Nadaf Z, Upadhya P, A J, K SA, Mohanty Mohapatra M. Cocaine-Induced Steroid Resistant Organising Pneumonia in a Young Male: The Lows of Getting High. Cureus 2023; 15:e46923. [PMID: 38022162 PMCID: PMC10640390 DOI: 10.7759/cureus.46923] [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] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Organizing pneumonia (OP) is a diffuse parenchymal lung disease occurring due to injury to the alveoli leading to typical histopathological features. Infections, connective tissue disorders, and medications are common aetiologies of OP. Cocaine-induced OP is uncommon. The patient had a fever and sore throat for two days corresponding to crack inhalation, followed by breathlessness that rapidly progressed to acute hypoxemic respiratory failure within one week. Radiology showed bilateral consolidation and ground glass opacities but did not respond to empiric treatment with antibiotics. After a multidisciplinary discussion, he was provisionally diagnosed as OP and treated with an intravenous methylprednisolone pulse dosage followed by oral prednisolone. OP was confirmed by surgical lung biopsy with the detection of Masson bodies. In view of progressive respiratory failure, steroid-resistant OP was diagnosed, and rituximab was administered as a second-line agent, but unfortunately, succumbed to respiratory failure. OP should be considered a differential in patients with consolidation who are non-responsive to initial conventional treatment. Multidisciplinary discussion and early lung biopsy to initiate immunosuppressants in the inflammatory stage of OP are emphasized for a possible better response.
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Affiliation(s)
- Zeenathalam Nadaf
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Pratap Upadhya
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Jeevanandham A
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Sai Anudeep K
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
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Ye B, Chen C, Huang L, Chen J, Weng Q, Wu W. Lesson of urgent bilateral lobar lung transplantation for acute fibrinous and organizing pneumonia: a case report. AME Case Rep 2023; 7:44. [PMID: 37942045 PMCID: PMC10628395 DOI: 10.21037/acr-22-88] [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: 10/26/2022] [Accepted: 08/13/2023] [Indexed: 11/10/2023]
Abstract
Background Acute fibrinous and organizing pneumonia (AFOP) is one of acute expiratory diseases, which occurs rarely with a difficult diagnosis. AFOP is related to an idiopathic cause or autoimmune disease, drug use, infection, cancer, or transplantation. Variation of treatment depends on different institutions. To date, no evidence shows that lobar lung transplantation is applied in an urgent situation such as AFOP. Case Description A 33-year-old female patient experienced fever, cough, and dyspnea four days prior to admission. She had no underlying health conditions. Initially, she received oxygen therapy and empiric antimicrobial treatment, but later developed pulmonary consolidation. Pathological examination confirmed the diagnosis of AFOP. Despite receiving standardized treatment involving extracorporeal membrane oxygenation (ECMO) and mechanical ventilation, the patient's respiratory function remained compromised. Consequently, an urgent lobar lung transplantation was performed. However, the patient encountered several challenges including carbapenem-resistant Pseudomonas aeruginosa pneumonia, exophytic granulation tissue, anastomotic stenosis, bronchopleural fistulae, anastomotic infections, septic shock, bacteremia, reperfusion syndrome, primary graft dysfunction, severe renal failure, and critical illness myopathy. Although the patient ultimately recovered and had a favorable survival outcome over 1-year post-discharge through multidisciplinary care, there are several key points to consider. Based on the findings from a systematic review, urgent transplantation may be a potential alternative treatment for AFOP. However, peri-transplantation programs should be enhanced, particularly regarding criteria selection, ECMO management, and the role of enhanced recovery after transplantation. Conclusions The case demonstrates the feasibility of bilateral lobar lung transplantation in patients with AFOP, especially in an urgent situation.
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Affiliation(s)
- Bing Ye
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Lin Huang
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Jingyu Chen
- Department of Lung Transplantation, Wuxi People’s Hospital, Nanjing Medical University, Wuxi, China
| | - Qinyong Weng
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weidong Wu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
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Liu WJ, Zhou S, Li YX. Two methods of lung biopsy for histological confirmation of acute fibrinous and organizing pneumonia: A case report. World J Clin Cases 2022; 10:13381-13387. [PMID: 36683623 PMCID: PMC9851008 DOI: 10.12998/wjcc.v10.i36.13381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/17/2022] [Accepted: 11/28/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Acute fibrinous and organizing pneumonia (AFOP) is a rare, noninfective lung disease, histologically characterized by a patchy distribution of intra-alveolar fibrin “balls” and organizing pneumonia. The clinical manifestations of AFOP are nonspecific. Diagnosis depends on pathology. Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP. However, many patients have no tolerance to the operation, including mentally and physically. There is still no standard therapy for AFOP and the methods remain controversial. Therefore, further clinical attention and discussion are warranted.
CASE SUMMARY A 53-year-old woman presented with fever, cough and dyspnea for 15 d. Anti-infective therapy was ineffective. Chest computed tomography showed bilateral patchy consolidation, especially in the lower lobes. We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations. Both samples supported the diagnosis of AFOP. The patient had a good clinical course after treatment with methylprednisolone, and no side effects of steroids.
CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy. Methylprednisolone alone is effective in the treatment of idiopathic AFOP.
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Affiliation(s)
- Wen-Juan Liu
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Shuang Zhou
- Department of Internal Medicine, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Yan-Xia Li
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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Chen H, Kuang Y, Huang X, Ye Z, Liu Y, Xie C, Tang KJ. Acute fibrinous and organizing pfneumonia: two case reports and literature review. Diagn Pathol 2021; 16:90. [PMID: 34629105 PMCID: PMC8502284 DOI: 10.1186/s13000-021-01155-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 09/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Acute fibrinous and organizing pneumonia (AFOP) is a rare histologic interstitial pneumonia pattern characterized by the intra-alveolar fibrin deposition and organizing pneumonia. Its clinical characteristics are still not well known and there is no consensus on treatment yet. Case presentation We report two female cases in their fifties diagnosed with AFOP confirmed by a second lung biopsy. Case 1 was idiopathic AFOP with manifestation of 6-week fever, dyspnea, and cough, while case 2 was secondary to systemic lupus erythematosus and fever was the major symptom. Their chest CT scans revealed bilateral multiple consolidations, predominantly in the lower lobes. Both cases were initially diagnosed with pneumonia, but did not improve after treatment with broad-spectrum antibiotics. In both cases, transbronchial biopsy and bronchoalveolar lavage fluid examination were inconclusive and the pathological diagnosis was confirmed by percutaneous lung biopsy. Both patients had a good clinical response to prednisone. Conclusions We report two rare AFOP cases to highlight the importance of awareness of this disease. We further perform the most comprehensive review to date in AFOP, including 150 patients since 2002. Consolidation was the most common imaging pattern, followed by ground-glass opacity and nodules. A lung biopsy is required for a definitive diagnosis. Corticosteroids is recommended as the most effective therapy, but treatment options should depend on the etiology and disease severity.
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Affiliation(s)
- Haihong Chen
- Division of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Province Guangdong, 510080, Guangzhou, People's Republic of China
| | - Yukun Kuang
- Division of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Province Guangdong, 510080, Guangzhou, People's Republic of China
| | - Xinyan Huang
- Division of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Province Guangdong, 510080, Guangzhou, People's Republic of China
| | - Ziyin Ye
- Department of Pathology, the First Affiliated Hospital of Sun Yat-sen University, Province Guangdong, Guangzhou, People's Republic of China
| | - Yangli Liu
- Division of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Province Guangdong, 510080, Guangzhou, People's Republic of China
| | - Canmao Xie
- Division of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Province Guangdong, 510080, Guangzhou, People's Republic of China
| | - Ke-Jing Tang
- Division of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Province Guangdong, 510080, Guangzhou, People's Republic of China.
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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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Johns M, George S, Taburyanskaya M, Poon YK. A Review of the Evidence for Corticosteroids in COVID-19. J Pharm Pract 2021; 35:626-637. [PMID: 33719698 DOI: 10.1177/0897190021998502] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To review available evidence on corticosteroids in acute respiratory distress syndrome (ARDS), Coronavirus Disease 2019 (COVID-19), and other viral pneumonias. DATA SOURCES A literature search of MEDLINE, PubMed and clinicaltrials.gov was performed to identify studies between 1980 to 2020 using the following search terms: corticosteroids, COVID19, severe respiratory syndrome coronavirus 2 (SARS-CoV-2), Middle East respiratory syndrome-related coronavirus (MERS-CoV), and influenza. Pre-printed articles were also reviewed at medRxiv.org. DATA ANALYSIS Corticosteroids were not recommended early in the COVID-19 pandemic outside of the use for concomitant indications (i.e. ARDS, septic shock) as they have been associated with delayed time to viral clearance in other viral pneumonias. A randomized trial showed a mortality benefit with dexamethasone in COVID-19. Guidelines have been updated to include a strong recommendation for their use in COVID-19 in those hospitalized requiring supplemental oxygen or mechanical ventilation. CONCLUSION Based on data from available randomized trials, patients that require respiratory support or mechanical ventilation benefit from corticosteroid therapy. Corticosteroids are an inexpensive and readily available therapy that should be standard of care in hospitalized COVID-19 patients requiring respiratory support.
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Affiliation(s)
- Meagan Johns
- Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephy George
- Department of Pharmacy, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, TX, USA
| | - Margarita Taburyanskaya
- Department of Pharmacy, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, TX, USA
| | - Yi Kee Poon
- Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, TX, USA
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