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Lim D, Tay SB. Cryptogenic Acute Fibrinous and Organizing Pneumonia: A Case Report. Cureus 2023; 15:e43563. [PMID: 37719530 PMCID: PMC10502916 DOI: 10.7759/cureus.43563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
We describe the case of a middle-aged male who presented with incidental findings of a left retrocardiac opacity seen on a chest radiograph. Subsequent computed tomography (CT) of the thorax showed multiple subpleural lesions with central necrosis. A diagnosis of acute fibrinous organizing pneumonia was made histologically upon biopsy of the subpleural lesions. The patient responded well to steroids, with full resolution of the subpleural lesions on repeat CT of the thorax. This report illustrates a case of acute fibrinous organizing pneumonia wherein the patient responded well to corticosteroids.
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Affiliation(s)
- Dorcas Lim
- Department of Internal Medicine, Sengkang General Hospital, Singapore, SGP
| | - Sok Boon Tay
- Department of Respiratory Medicine, Sengkang General Hospital, Singapore, SGP
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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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Cendon L, Rafecas Codern A, de la Rosa D, Castellví I, Spagnolo P, Castillo D. Systematic Review of Systemic Corticosteroids for Treatment of Organizing Pneumonia. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37496960 PMCID: PMC10369534 DOI: 10.1016/j.opresp.2022.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Regardless corticosteroids are recommended for the treatment of organizing pneumonia there is limited evidence supporting this practice. Thus, we performed a systematic review of the literature on systemic corticosteroid treatment for organizing pneumonia. Methods A search was implemented in the PubMed database (Medline) for articles published in the last 20 years. Those studies with incomplete or insufficient data and case reports were excluded. We collected data including: demographics, clinical data, diagnostic procedures, aetiology, treatment regimen (drug, posology, duration, response) and evolution. Results A total of 135 publications were selected and finally 13 studies with 849 patients were included in the review: 12 retrospective observational studies and a single prospective observational study. Most of the patients were started on treatment with systemic corticosteroids - a total of 627 (30-100% depending on the series), but there was a great heterogeneity regarding drug, doses and duration. On those that started treatment, 226 (36%) presented a relapse of the disease during follow-up. Only one study provided information regarding treatment side-effects. Conclusion The findings of this systematic review show the low quality data supporting the use of corticosteroids for the treatment of organizing pneumonia. This highlights a need to undertake appropriately designed studies to investigate which is the most appropriate treatment regimen that trades off benefits and risks of prolonged corticosteroid administration.
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Lu Y, Zheng W, Cao W, Yang X, Zhao L, Chen Y. Acute fibrinous and organizing pneumonia in a patient with Sjögren's syndrome and Legionella pneumonia: a case report and literature review. BMC Pulm Med 2022; 22:205. [PMID: 35610634 PMCID: PMC9128202 DOI: 10.1186/s12890-022-01997-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/13/2022] [Indexed: 01/03/2023] Open
Abstract
Background Acute fibrinous and organizing pneumonia (AFOP) is a rare clinicopathological condition. Studies in the literature have reported that AFOP may be associated with respiratory infections, such as respiratory syncytial virus, influenza virus, Pneumocystis jirovecii, Penicillium citrinum, and Chlamydia infections. However, AFOP associated with Legionella infection has not been reported previously. Here, we report a case of a patient with AFOP secondary to Sjögren’s syndrome and Legionella infection. Case presentation A 47-year-old man was admitted to the hospital because of fever, expectoration, and shortness of breath. Lung imaging showed irregular patchy consolidation. A diagnosis of Legionella pneumonia was initially considered on the basis of the patient’s history of exposure to soil before disease onset, signs of extrapulmonary involvement, and a positive Legionella urine antigen test result. However, the patient’s symptoms and lung imaging did not improve after treatment with levofloxacin, moxifloxacin, and tigecycline for Legionella infection. In addition, Sjögren’s syndrome was diagnosed on the basis of clinical manifestations and immunological indicators. Pathological changes associated with AFOP were confirmed from the results of ultrasound-guided percutaneous lung biopsy. The patient’s clinical symptoms improved rapidly after a short course of low-dose corticosteroid therapy, and lung imaging showed significant improvement. Conclusions The possibility of secondary AFOP should be considered when Legionella pneumonia does not improve after standard antibiotic therapy. Lung biopsy and histopathological examination are important for the adjustment of treatment strategy. Our case also highlights the importance of screening for autoimmune diseases in patients with AFOP.
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Affiliation(s)
- Ye Lu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Zheng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Cao
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xianghong Yang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Chen
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
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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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Nanno S, Koh H, Okamura H, Nishimoto M, Nakashima Y, Ohsawa M, Hino M, Nakamae H. Acute fibrinous and organizing pneumonia following hemophagocytic syndrome in two adult patients with hematological malignancies. J Clin Exp Hematop 2021; 61:93-96. [PMID: 33883345 PMCID: PMC8265494 DOI: 10.3960/jslrt.20042] [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] [Indexed: 11/08/2022] Open
Abstract
Acute fibrinous and organizing pneumonia (AFOP) is a rare acute lung injury featuring pathological intra-alveolar fibrin balls and organizing pneumonia without hyaline membranes or eosinophils. AFOP forms acute and subacute patterns; the former often has a poor prognosis, whereas the latter has better survival. Secondary hemophagocytic syndrome (HPS) is a cytokine-related and potentially lethal disorder induced by various diseases, and pulmonary involvement in HPS is not rare. However, to our knowledge, no report has addressed the association between secondary HPS and AFOP development. We report two cases of subacute AFOP following HPS in hematological malignancies.
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Affiliation(s)
- Satoru Nanno
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hideo Koh
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroshi Okamura
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Mitsutaka Nishimoto
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasuhiro Nakashima
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masahiko Ohsawa
- Diagnostic pathology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masayuki Hino
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hirohisa Nakamae
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Matsunawa M, Inoue Y, Yagihashi K, Aida Y, Uchida A, Uemura Y, Saiki Y, Takimoto M, Sano F, Miura I, Arai A. The clinicopathological analysis of organising pneumonia in myelodysplastic syndrome: high frequency in der(1;7)(q10; p10). Br J Haematol 2021; 194:214-217. [PMID: 33855707 DOI: 10.1111/bjh.17473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Manabu Matsunawa
- Department of Internal Medicine, Division of Hematology, Yokohama City Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Yasuyuki Inoue
- Department of Internal Medicine, Division of Hematology, Yokohama City Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Kunihiro Yagihashi
- Department of Radiology, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Yoshio Aida
- Department of Pathology, Yokohama City Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Akiko Uchida
- Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yu Uemura
- Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yusuke Saiki
- Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Madoka Takimoto
- Department of Internal Medicine, Division of Hematology, Yokohama City Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Fumiaki Sano
- Department of Internal Medicine, Division of Hematology, Yokohama City Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan
| | - Ikuo Miura
- Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayako Arai
- Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Hematological Therapeutics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Yuan HB, Wang XY, Sun JY, Xie FF, Zheng XX, Tao GY, Pan L, Hogarth DK. Flexible bronchoscopy-guided microwave ablation in peripheral porcine lung: a new minimally-invasive ablation. Transl Lung Cancer Res 2019; 8:787-796. [PMID: 32010557 DOI: 10.21037/tlcr.2019.10.12] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Transbronchial lung biopsy is an important approach to diagnose peripheral lung cancer, but bronchoscopy based treatment options are limited and poorly studied. A flexible bronchoscopy-guided water-cooled microwave ablation (MWA) catheter was developed to evaluate the feasibility and safety both in ex vivo and in vivo porcine models. Methods Using direct penetration of the catheter through the surface of ex vivo porcine lung, ablations (n=9) were performed at 70, 80, 90 W for 10 minutes. Temperatures of the catheter and 10, 15, 20 mm away from the tip were measured. Under bronchoscopy conditions in porcine lung, ablations (n=18, 6 in ex vivo and 12 in vivo) were performed at 80 W for 5 minutes. Computed tomography (CT) was acquired perioperative, 24 hours, 2 weeks, and 4 weeks post ablation. Ablation zones were excised at 24 hours and 4 weeks respectively. Long-axis diameter (Dl) and short-axis diameter (Ds) were measured and tissues were sectioned for pathological examination. Results In-ex vivo lung, the temperature at 20 mm removed was over 60 °C at 80 W for 288±26 seconds. The ablations under bronchoscopic conditions were successful in-ex vivo and in vivo lung. No complications occurred during the procedures. Coagulation necrosis was visible at 24 hours, and repaired fibrous tissue was seen at 4 weeks. Conclusions The flexible bronchoscopy-guided water-cooled MWA is feasible and safe. This early animal data holds promise of MWA becoming a potential therapeutic tool for Peripheral Lung Cancers.
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Affiliation(s)
- Hai-Bin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiang-Yu Wang
- Department of Respiration, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 451200, China
| | - Jia-Yuan Sun
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Fang-Fang Xie
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Xiao-Xuan Zheng
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Guang-Yu Tao
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Lei Pan
- Department of Respiration, Shanghai Public Health Clinic Center, Fudan University, Shanghai 201058, China
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