Abstract
BackgroundAcute Fibrinous and Organizing Pneumonia is a rare entity characterized by the histological pattern suggestive of diffuse alveolar damage, eosinophilic pneumonia and organizing pneumonia; the presence of intra alveolar “fibrin balls” distinguishes it from these conditions. Herein, we describe the association of acute fibrinous and organizing pneumonia with a respiratory tract infection. We believe that such an association has been extremely rarely described.Case presentationWe report the case of a 68 year old female patient of Afghan descent who presented with shortness of breath, cough and high grade fever not responding satisfactorily to standard antibiotic therapy. Imaging revealed bilateral basilar infiltrates and ground glass opacification of the right lower lung zone. Though the inflammatory markers decreased with antibiotic therapy, there was minimal improvement in the patient’s symptoms and radiological appearance of the lungs. Bronchoscopy was refused by the patient’s family and a Computed Tomography guided biopsy of the lung revealed a histological diagnosis of acute fibrinous and organizing pneumonia. Patient was initiated on high dose intravenous corticosteroid therapy followed by a maintenance dose of prednisolone at 40 mg/day. She recovered dramatically. However, due to poor compliance with treatment, she relapsed and was re-treated with the same regimen. Currently she is completely symptom free and is on a tapering corticosteroid dose.ConclusionWe conclude that AFOP may be a rare but under diagnosed entity and recommend that it should be considered in the differentials of a suspected pulmonary infection unresponsive to optimum antibiotic therapy.
Highlights
Acute Fibrinous and Organizing Pneumonia is a rare entity characterized by the histological pattern suggestive of diffuse alveolar damage, eosinophilic pneumonia and organizing pneumonia; the presence of intra alveolar “fibrin balls” distinguishes it from these conditions
We conclude that Acute fibrinous and organizing pneumonia (AFOP) may be a rare but under diagnosed entity and recommend that it should be considered in the differentials of a suspected pulmonary infection unresponsive to optimum antibiotic therapy
We present the case of an elderly female patient who presented to us with signs, symptoms, laboratory parameters and radiological features of typical community acquired pneumonia (CAP) not responding adequately to optimum antibiotic therapy
Summary
From this case we conclude, that AFOP is a rare clinical pattern of lung injury and should be considered as a differential in patients with suspected CAP unresponsive to standard antibiotic therapy. AFOP might represent an under diagnosed and under reported condition, especially in the developing countries This may be due to the complicated means of obtaining a tissue diagnosis which are not present in most tertiary care settings of our region. He was involved in planning of various investigations for the patient He performed the literature review, drafted the manuscript, reviewed it critically and approved it the end for submission. He was involved in retrieving high quality images for publication from the pathology and radiology archives. Both authors read and approved the final manuscript
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