Acute fibrinous and organizing pneumonia: a case report and review of the literature

Abstract

To better understand the clinical and pathological characteristics of acute fibrinous and organizing pneumonia (AFOP). A case diagnosed with AFOP was reported and the related literature was reviewed. A 73 year-old man presenting with fever, cough with small amount of white sputum and gradually worsening dyspnea was admitted to this hospital. Chest CT scan showed bilateral multiple nodules and patchy infiltrates. Treatment including anti-bacterial and anti-fungal drugs was initiated, but no improvement was observed. The dyspnea deteriorated and repeated chest CT showed an increase of the nodules and the patchy infiltrates. Ultrasound guided percutaneous lung biopsy was performed and the pathological examination revealed slightly widened alveolar septa, lymphocyte and plasma cell infiltration and the presence of intra-alveolar fibrin in the form of fibrin "balls" (organization) within the alveolar spaces. No neutrophil and eosinophil infiltration was detected. The finding was consistent with AFOP. Corticosteroid therapy was started and the patient showed significant clinical and radiological improvement after a course of treatment. The patient was discharged and followed in the outpatient clinic. The chest CT became nearly normal after treatment with corticosteroids for 1.5 months. The main clinical manifestations of AFOP were similar to those of acute lung injury. Diagnosis was made by lung biopsy. The optimal treatment for AFOP had not been established. Therapy with corticosteroids could be attempted, but relapse may occur during the period of reducing the dosage of corticosteroids.