Acute Fibrinous and Organizing Pneumonia: A Case Report and Review of the Literature

Abstract

BACKGROUND Acute fibrinous organizing pneumonia (AFOP) is a rare condition of the lung that is associated with acute lung injury, and has a poor prognosis. AFOP is characterized histologically by intra-alveolar fibrin. AFOP has been described to be associated with lung infections, connective tissue disorders, drugs, toxic environmental exposure, and in lung transplantation. However, most cases of AFOP remain idiopathic, and because the condition can present with a wide variety of clinical manifestations, open lung biopsy or video-assisted thoracoscopic (VAT) lung biopsy is necessary for the diagnosis. Currently, treatments for AFOP remain under investigation. CASE REPORT A 35-year-old woman presented with a cough and dyspnea, and was initially diagnosed to have pneumonia. Due to the progression of her symptoms and increasing respiratory failure she underwent video-assisted thoracoscopic (VAT) biopsy and was diagnosed with AFOP, 19 days following hospital admission. She was treated with mechanical ventilation, intravenous steroids, and cyclophosphamide. She required tracheostomy after 14 days of mechanical ventilation and died two weeks later. CONCLUSIONS AFOP is an uncommon clinical condition, with a poor prognosis, which often has a delay in diagnosis. Some patients benefit from steroids and immunosuppressive therapy. Currently, new treatments for AFOP are under investigation.

Figure 1.

Chest X-radiograph in a case of acute fibrinous organizing pneumonia (AFOP). Chest radiograph shows bilateral parenchymal infiltrates, predominantly in the left lower lobe.

Figure 2.

Non contrast-enhanced chest computed tomography (CT) in a case of acute fibrinous organizing pneumonia (AFOP). Non contrast-enhanced chest computed tomography (CT) shows consolidation of the left lower lobe with an air bronchogram.

Figure 3.

Photomicrographs of the histology of the appearance of acute fibrinous organizing pneumonia (AFOP) on lung biopsy. (A) (Low power) and (B) (high power) photomicrographs of the histopathology of a lung biopsy from this case, showing the typical appearances of acute fibrinous organizing pneumonia (AFOP). The alveolar spaces are dilated, and some are filled with intact red cells (arrow head), and others are filled with eosinophilic (pink) fibrin (arrows), but there are no hyaline membranes. Hematoxylin and eosin (H&E) stain.