Bronchiolitis Obliterans With Organizing Pneumonia Research Articles

Acute necrotizing myopathy associated with bronchiolitis obliterans with organizing pneumonia (BOOP) responding to treatment with rituximab and steroids. (P3.462)

Acute necrotizing myopathy associated with bronchiolitis obliterans with organizing pneumonia (BOOP) responding to treatment with rituximab and steroids. (P3.462)

P.Vivax Malaria Causing BOOP: A Rare Complication

India and African countries are said to endemic to malaria. P. Falciparum malaria practically can cause anything as we have read in the articles, but complications with P.vivax are not common. Bronchiolitis obliterans with organizing pneumonia (BOOP) is one of the rare lung diseases. Here we are presenting a case of P.Vivax malaria complicated by BOOP which is a very rare complication.

Corticosteroid therapy against treatment-related pulmonary toxicities in patients with lung cancer.

With the recent increased use of new anti-neoplastic agents, molecular-targeted drugs and radiation in patients with lung cancer, there has been an increase in the occurrence drug-induced or radiation-induced pulmonary toxicities. We conducted this study to evaluate the clinical characteristics of patients with lung cancer who presented with treatment-related pulmonary toxicities and to analyze the dosage pattern of corticosteroid therapy against them. To collect the baseline data from the patients with lung cancer who developed treatment-related pulmonary toxicities, we initially selected those who were prescribed corticosteroids between January 1, 2008 and December 31, 2012. Depending on clinical and radiological diagnoses, we classified pulmonary toxicities into drug-induced interstitial lung disease (DILD), radiation pneumonitis, acute exacerbation of chronic obstructive pulmonary disease (AE COPD) and others. We divided total patients (n=398) into four groups, and these include 88 cases (22%) of DILD, 189 cases (47%) of radiation pneumonitis, 47 cases (12%) of AE COPD and 74 cases (19%) of others. The prescribed rate of pulse or high-dose steroid was measured as 73%, 20%, 40% and 38%, respectively (P<0.001). In DILD radiologic findings, the 2-month mortality was significantly higher in the patients with the diffuse alveolar damage (DAD) pattern (100%) as compared with those with the non-specific interstitial pneumonia (NSIP) or bronchiolitis obliterans with organizing pneumonia (BOOP) one (62% or 42%, respectively) (P=0.032). This study showed that the natural course of DILD had more unfavorable outcome requiring higher dose steroid therapy as compared with those with radiation pneumonitis or AE COPD. According to a subgroup analysis of the patients with DILD, BOOP and NSIP radiographic patterns showed more favorable outcomes.

FRI0151 Clinical features of organizing pneumonia associated with rheumatoid arthritis; development of organizing pneumonia is not related to disease activity of arthritis

BackgroundOrganizing pneumonia (OP), different name: bronchiolitis obliterans with organizing pneumonia (BOOP), is a form of interstitial lung diseases characterized by presence of buds of granulation tissue in bronchiole and alveoli....

Acute eosinophilic pneumonia related to a mesalazine suppository

It has been well known that mesalazine can cause the interstitial lung disease, such as Bronchiolitis obliterans with organizing pneumonia (BOOP), Non-Specific Interstitial Pneumonia (NSIP), or eosinophilic pneumonia. 5-Aminosalicylic acid (5-ASA), mesalazine, and sulfasalazine are important drugs for treating inflammatory bowel disease. Topical products of these limited systemic absorption and have less frequent side effects, therefore suppository form of these drugs have been used more than systemic drug. Most cases of measalzine-induced lung toxicity develop from systemic use of the drug. A 30-year-old woman had an interstitial lung disease after using mesalazine suppository because of ulcerative colitis. The lung biopsy demonstrated eosinophilic pneumonia combined with BOOP. She was recovered after stopping of mesalazine suppository and treatment with systemic steroid.

Successful treatment of Bronchiolitis obliterans with organizing pneumonia in dialysis patient

A 42-year-old end stage renal disease (ESRD) patient was admitted with fever, anorexia, malaise, non-productive cough, and dyspnea, of one-week duration. Multiple cultures of the blood, sputum, and urine were negative for microorganisms. The possibility of bronchiolitis obliterans with organizing pneumonia (BOOP) was considered when patient with pulmonary infiltrate did not respond to conventional antibiotic therapy and frequent hemodyalisis. High-resolution computed tomography of the chest revealed patchy air-space consolidation, ground-glass opacities, and small nodular opacities, predominantly located at the peripheral part of the lungs. Cultures and stains of bronchoalveolar lavage (BAL) specimen and bronchoscopic biopsy of lung tissue were negative for organisms [bacteria, mycobacterium tuberculosis, PCP, fungus, and atypical organism] and showed evidence of BOOP. Patient recovered completely with early diagnosis and treatment with steroids and underwent successful renal transplantation with wife as donor without postoperative complication and relapse.

Fatal Outcomes in Family Transmission of Mycoplasma pneumoniae

Mycoplasma pneumoniae continues to be a significant cause of community-acquired pneumonia and, on rare occasions, manifests as fulminant disease that leads to mortality, even in healthy individuals. We conducted a retrospective study on members of a family who were quarantined by the Centers for Disease Control and Prevention in 2002 for respiratory failure and death of a 15-year-old brother (sibling 1) and a 13-year-old sister (sibling 2). Collected airway, cerebrospinal fluid (CSF), and serum samples from both deceased siblings and serum samples from both parents and the remaining 3 ill siblings (sibling 3-5) were tested using a range of diagnostic assays. Autopsy lung tissue samples from sibling 2 were also assessed using immunohistochemical and immunoelectron microscopic methods. Autopsy evaluation of sibling 1 revealed cerebral edema consistent with hypoxic ischemic encepatholopathy and pulmonary findings of bronchiolitis obliterans with organizing pneumonia (BOOP). Postmortem lung examination of sibling 2 revealed lymphoplasmacytic bronchiolitis with intraluminal purulent exudate, BOOP, and pulmonary edema. Results of diagnostic assays implicated the household transmission of M. pneumoniae among all 5 siblings and both parents. Further analysis of lung tissue from sibling 2 demonstrated the presence of M. pneumoniae organisms and community-acquired respiratory distress syndrome toxin. M. pneumoniae was cultured directly from sibling 2 autopsy lung tissue. Evidence is provided that M. pneumoniae was readily transmitted to all members of the household and that the resulting infections led to a spectrum of individual responses with variation in disease progression, including lymphoplasmacytic bronchiolitis, BOOP, and death.

Diagnostic Failure of Ciprofloxacin-Induced Spontaneous Bilateral Achilles Tendon Rupture: Case-Report and Medical-Legal Considerations

Rare side-effects of fluoroquinolone therapy are tendinitis and tendon rupture. Many reports have demonstrated that the concomitant use of corticosteroids, in patients aged 60 years or older, increase the risk substantially. We present a case of spontaneous bilateral Achilles tendon rupture induced by ciprofloxacin and methylprednisolone. A 61-year-old woman was diagnosed with Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) and was started on oral ciprofloxacin 500 mg twice daily for 3 weeks and on oral methylprednisolone 16 mg twice daily for 2 weeks. The diagnosis was made after doctors, rather than stop drug therapy and advise complete rest, had mistakenly prescribed for the woman to undergo physiotherapy and local NSAIDs, thus favoring the onset of tendon ruptures and resulting in surgical and legal implications. Inspired by this case, we also submit a brief review on professional liability in Orthopaedics.

Home Telemetric Monitoring of Pulmonary Function After Allogeneic Hematopoïetic Stem Cell Transplantation: Results of a Prospective Study Including 120 Patients.

Abstract 3315Poster Board III-203 BackgroundLate-onset noninfectious pulmonary complications (LONIPC) are both frequent and severe complications of allogeneic hematopoietic stem cell transplantation (HSCT). They include bronchiolitis obliterans (BO), interstitial pneumonitis (IP) and bronchiolitis obliterans with organizing pneumonia (BOOP). Their outcome is usually unfavourable. Early diagnosis and treatment may improve the prognosis. We assessed the feasibility and benefits of home surveillance of pulmonary function for early diagnosis of LONIPC in allogeneic HSCT recipients. Patients and methodsThis prospective study included all patients with a landline telephone living in Paris area. Monitoring with a portable spirometer (spirotel®, M-Elect France) was scheduled to start 3 months after transplant and has been performed for 18 months, or longer if respiratory failure occured. Vital capacity (VC), forced expiratory volume per second (FEV1) and mid expiratory flow 25 to 75 values (FEF25-75) were measured. Data was transmitted by phone to hospital twice a week. If significant deterioration occurred, defined by at least a 20% drop, spirometry and plethysmography were performed, and if alterations of pulmonary functions were confirmed, further investigations (thorax CT-scan and fiberoptic bronchoscopy with broncho-alveolar lavage.) were performed in the pneumology unit. ResultsBetween June 2001 and November 2008, 336 patients received a HSCT in the hematology unit of Pitié-Salpêtrière Hospital. One hundred and ninety one patients were included in the study before transplant. One hundred and twenty patients were actually equipped after transplant, whereas 71 were excluded because of poor clinical status or early death. Median age of the 120 equipped patients was 46 (20-66) years. HSCT was performed with HLA sibling donor in 52.5% and myeloablative conditioning regimen in 60%. Acute graft-versus-host disease (GVHD) grade II-IV occurred in 44% patients and chronic GVHD in 57%. During monitoring, 32 confirmed telemetric deteriorations occurred in 25 patients at a median time of 15 months post-transplant (3-61). They allowed the diagnosis of LONIPC in 12 patients (6 BO, 1 IP, 4 patients presented both BO and IP (BO-IP)). The thirtheen remaining patients presented infection (N=5), cardiac failure (N=3), asthma (N=3) or others (N=2). During, the whole follow-up, 28 patients presented LONIPC (16 BO, 5 IP, 7 BO-IP). Twelve of them were detected by telemetric spirometry, whereas LONIPC occurred before the onset or after the end of the monitoring in 11 patients. In 3 cases of IP, 1 case of BO and 1 case of BO-IP, the diagnosis of LONIPC was not performed by telemetric monitoring.Treatment consisted in introduction or increasing of systemic immunosuppressive therapy for 23/28 patients, the 5 remaining patients were exclusively treated with azithromycin and/or inhaled steroids and long acting β2 mimetics. At the last follow up (25±20 months post-transplant), lung functional improvement (defined as improvement of FEV1>200mL) was observed in 54% patients, functional deterioration (defined as a decreasing of the FEV1> 200mL) was observed in 14% patients, and functional stabilization in 32%. Functional improvement occurred in 80% and 86% in patients with IP and BO-IP respectively, and in 31% patients with BO. During follow-up no death related to LONIPC occurred ConclusionHome telemetric surveillance allowed an early detection of LONIPC. With precocious diagnosis and treatment, no death related to LONIPC was observed, and a functional improvement occurred for 54% patients, especially those suffering IP or BO-IP. DisclosuresNo relevant conflicts of interest to declare.

Probable nitrofurantoin-induced bronchiolitis obliterans with organizing pneumonia

A case of bronchiolitis obliterans with organizing pneumonia (BOOP) that developed after three years of nitrofurantoin therapy is described. An 89 year-old Caucasian woman weighing 60 kg with diastolic heart failure and a history of urosepsis, viral pericarditis, and atrial fibrillation arrived at the emergency department with worsening dyspnea, shortness of breath that had limited her activities of daily living for three days, and lower extremity edema. Over the previous six months the patient had experienced decreased appetite, abdominal bloating, and a 9.1-kg weight loss. Four months prior, the primary physician diagnosed her symptoms of worsening dyspnea at rest and with exertion as severe bronchitis. Imaging at the time of presentation revealed interstitial fibrosis consistent with nitrofurantoin-induced BOOP. A diagnosis of BOOP was made, nitrofurantoin was discontinued, and the patient was discharged home on oxygen. Prednisone 20 mg was started two weeks later, after no improvement in symptoms was seen. Seven weeks after nitrofurantoin discontinuation, the results of a chest radiograph and computed tomography scan were unchanged, but her symptoms had improved by 20%. The patient was readmitted three weeks later for worsening dyspnea, and it was determined that prednisone had resulted in fluid retention, complicating her diastolic congestive heart failure. Prednisone therapy was therefore tapered off after two months of treatment. No improvement in subjective symptoms, in chest radiograph results, or in BOOP symptoms was seen after three months of prednisone discontinuation and five months of nitrofurantoin discontinuation. An 89-year-old woman developed unresolving BOOP after three years of nitrofurantoin therapy.

Interstitial pneumonia associated with progression of myelodysplastic syndrome

Pulmonary complications are common in patients with myelodysplastic syndrome (MDS) and may be caused by infections, heart failure, hemorrhage, chemotherapy and rarely by leukemic infiltration of the parenchyma of the lungs [1]. Besides these conditions, MDS is rarely complicated by interstitial lung diseases, such as interstitial pneumonia [2, 3], bronchiolitis obliterans with organizing pneumonia (BOOP) [1, 4], and lung involvement associated with Sweet’s disease [1, 5, 6]. Here, we describe a case of steroid-responsive interstitial pneumonia, which developed in parallel with the progression of MDS. A 76-year-old Japanese woman who had been diagnosed with refractory anemia (RA) with normal karyotype 6 years previously was admitted to our hospital because of a 2-week history of fever, productive coughs and respiratory distress. On admission, physical examination disclosed a temperature of 37.5 C and coarse crackles over the lower fields of both lungs. Hematologic examination demonstrated a WBC count of 5.1 9 10/L with 2% blasts; a hemoglobin concentration of 8.7 g/dL and a platelet count of 378 9 10/L. She also had high levels of serum lactate dehydrogenase (528 IU/L) and C-reactive protein levels (7.24 mg/dL). Arterial blood gas analysis on room air showed an oxygen partial pressure of 54.4 mmHg, carbon dioxide partial pressure of 41.5 mmHg and pH of 7.47. Serology for autoimmune diseases and fungal antigen tests were negative. Blood and sputum cultures were negative for pathogens. Bone marrow aspirate and biopsy demonstrated hypercellular marrow with 15% blasts, and trilineage dysplasia without myelofibrosis. Cytogenetic analysis demonstrated an abnormal complex karyotype: 47,XX, der (5;17) (p10; q10), ?8, del (13) (q12q14) in the bone marrow cells. Thus, disease progression of RA to refractory anemia with excess blasts (RAEB)-2 was confirmed. Chest roentgenogram showed patchy infiltrates in the lower lobes of both lungs. A computed tomography (CT) scan of the chest demonstrated multiple patchy consolidation and ground-grass opacities in both lungs (Fig. 1a). Despite empirical treatment with broad-spectrum antibacterial and antifungal agents, oxygenation progressively deteriorated and fever persisted over the following weeks. Subsequent CT scan of the chest showed that the infiltrates had expanded and migrated along the bronchovascular bundles, suggesting BOOP. She had high levels of serum sialylated carbohydrate antigen KL-6 (1160 U/mL; normal range 0.0–500.0 U/mL) and surfactant protein D (419.1 ng/mL; normal range 0.0–110.0 ng/mL). Thereafter, fiberoptic bronchoscopy was performed, which did not show any endobronchial abnormalities. Bronchoalveolar lavage (BAL) fluid analysis demonstrated increased total cell count (5.3 9 10/mL), which was predominantly composed of lymphocytes with an elevated CD4/8 ratio of 2.53. Neither pathogenic microorganisms nor malignant cells were observed in the BAL fluid. Fluorescence in situ hybridization analysis detected an increase of cells showing trisomy 8 (6%), which should represent the MDS clone, in BAL fluid. Although radiographic and BAL findings suggested BOOP, histological examination of the specimen obtained by transbronchial lung biopsy demonstrated alveolitis with lymphocyte infiltration, which is compatible K. Kataoka M. Ichikawa A. Hangaishi T. Takahashi Y. Imai M. Kurokawa (&) Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan e-mail: kurokawa-tky@umin.ac.jp

Late-onset non-infectious pulmonary complications following allogeneic hematopoietic stem cell transplantation in children

Late-onset non-infectious pulmonary complications (LONIPCs) that arise beyond 3 months after allogeneic hematopoietic SCT include bronchiolitis obliterans (BO), bronchiolitis obliterans with organizing pneumonia (BOOP) and idiopathic pneumonia syndrome (IPS). We retrospectively analyzed the incidence and outcome of LONIPCs among pediatric hematopoietic SCT recipients. We included 97 patients who survived for more than 3 months among the 114 who underwent allogeneic hematopoietic SCT between April 1997 and May 2007. Of the 97 enrolled patients, 10 (10.3%) developed LONIPCs at a median of 187 days after hematopoietic SCT (range, 123-826 days). Of the 10 patients with LONIPCs, eight had BO and two had IPS. Multivariate analysis showed that the onset of LONIPCs was associated with high-risk underlying disease and extensive chronic GVHD (hazard ratio, 5.42 (95% confidence interval, 1.36-21.7) and hazard ratio, 11.7 (95% confidence interval, 2.40-57.1), respectively). Only two patients responded to therapy with steroids and six of the 10 patients died. The 5-year OS rate was significantly lower among patients with, than without LONIPCs (28.0 vs 87.2%, P=0.000). Considering that we are lacking optimal therapies for LONIPCs, strategies aimed at the prevention of LONIPCs should be attempted.

Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) in a Patient with Rheumatoid Arthritis

Interstitial lung disease (ILD) is one of the common extra-articular manifestations of rheumatoid arthritis (RA). Bronchiolitis obliterans with organizing pneumonia (BOOP) is one type of ILD, and this is characterized by the proliferation of granulation tissue in the bronchioles, alveolar ducts and some alveoli and interstitial infiltration by chronic inflammatory cells. It develops as a manifestation of RA or as a side effect of anti-rheumatic drugs in patients with RA. We experienced a 41-year-old female patient with RA who developed BOOP during the treatment with methotrexate and bucillamine. She presented with cough and sputum for several months and pleuritic chest pain for one week. The chest radiograph showed bilateral multifocal consolidations. She received thoracoscopic biopsy and her pulmonary infiltrations resolved after the treatment with corticosteroid.

Monitoring of glucocorticoid therapy by assessment of CD14 +CD16 + monocytes: A case report

Bronchiolitis obliterans with organizing pneumonia (BOOP) is a disease affecting small airways and alveoli. It is characterized by interstitial inflammation rich in foamy macrophages and by fibroblastic connective tissue expanding into the airway and alveolar lumen. We report herein on a 54-year-old male BOOP patient who was treated with glucocorticoids (GCs) and who over a 5-year period had three relapses. At diagnosis the patient showed elevated CD14 +CD16 + monocyte numbers (85 cells/μl) and increased serum C-reactive protein (CRP) levels (29.4 mg/l). With GC therapy both parameters decreased within a few days. Diagnosis of relapse was preceded by a rise in CD14 +CD16 + monocyte numbers and in CRP levels which again responded to GC treatment. We conclude that determination of CD14 +CD16 + monocytes is a useful marker for monitoring of BOOP diagnosis and GC therapy.

A Case of Endobronchial Lipoma Causing Right Middle and Lower Lobes Collapse and Bronchiolitis Obliterans-organizing Pneumonia

Lipoma is a common neoplasm in soft tissues. However, an intrapulmonary lipoma is a rare benign tumor. Patients with a bronchial lipoma might have a malignant potential related to their smoking history due to the case reports of lung cancer accompanied with lipoma. Endobronchial lipoma can cause irreversible parenchymal lung damage if not diagnosed and treated early. Therefore, it should initially be treated by fiberoptic bronchoscopy or surgery depending on the status of distal parenchymal lung damage. Bronchiolitis obliterans with organizing pneumonia (BOOP) is a pathological syndrome that is defined by the presence of buds of granulation tissue consisting of fibroblasts and collagen within the lumen of the distal air spaces. BOOP is caused by drug intoxication, connective tissue disease, infection, obstructive pneumonia, tumors, or an unknown etiology. We encountered a 58 year-old male patient with endobronchial lipoma, causing the collapse of the right middle and lower lobes, and BOOP due to obstructive pneumonia.

A Case of Secondary Organizing Pneumonia Occurring in Therapy for Lung Abscess

The patient is a 62-year-old man with known diabetes mellitus who presented with a two-weeks-history of dyspnea, cough, and fever. He was diagnosed with a lung abscess in the right upper lobe and was treated with intravenous antibiotics. The patient's clinical and radiological findings improved within seven days after medical treatment. However, newly developed ground-glass opacity and infiltrations were obs erved in the right lower lung. Fourteen days after admission, the patient's symptoms and imaging finding became aggravated despite trestment with susceptible antibiotics for lung abscess. Trans-bronchial lung biopsy (TBLB) was performed in the lateral basal segment of the right lower lobe of the lung. A histologic photomicrograph showed organizing pneumonia, also called bronchiolitis obliterans with organizing pneumonia(BOOP), that became more definite as the terminal bronchioles and alveoli became occluded with masses of inflammatory cells and fibrotic tissue. The clinical symptoms and radiograph findings resolved quickly with prednisone treatment. We report a case of secondary organizing pneumonia diagnosed after TBLB following lung abscess treatment and provide a review of the literature. (Tuberc Respir Dis 2007; 62: 540-544)

Bronchiolitis obliterans with organizing pneumonia after rituximab therapy for non‐Hodgkin's lymphoma

Rituximab is a chimeric, anti-CD20 monoclonal antibody initially approved for relapsed, refractory indolent B-cell non-Hodgkin's lymphoma (NHL), and is being applied in an increasing variety of clinical scenarios. Most adverse events are due to an infusion-related symptom complex, and severe pulmonary complications are rare. We describe a case of an NHL patient who received rituximab and developed symptomatic, biopsy-proven multinodular bronchiolitis obliterans with organizing pneumonia (BOOP). This is the first reported case of BOOP associated with single-agent rituximab, and along with two other patients we describe, as well as two prior reports of BOOP in NHL patients receiving rituximab-based combinations, strengthens the possibility of a causal relationship. Moreover, these findings suggest that the incidence of BOOP following rituximab therapy may be higher than has been previously appreciated. Physicians utilizing rituximab should be aware of this association given the difficulty of differentiating between presentations of BOOP and neoplastic pulmonary processes.

A Case of Acute Fibrinous and Organizing Pneumonia

Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern consisting of prominent intra-alveolar fibrin and organizing pneumonia, with out hyaline membranes or prominent eosinophilia. The clinical manifestations of AFOP resemble those of acute lung injury such as acute interstitial pneumonia (AIP). However, the classic histological patterns of AFOP differ from diffuse alveolar damage (DAD), bronchiolitis obliterans with organizing pneumonia (BOOP) or acute eosinophilic pneumonia (AEP). The characteristic intra-alveolar fibrin ball and lack of classic hyaline membrane are the predominant histological features of AFOP. Although some reports suggest that its clinical course is less catastrophic than DAD, the clinical entity that distinguishes AFOP from DAD has not been established. We present a case of pathologically demonstrated AFOP in a 79-year-old man. The radiological findings of our case were similar to those of DAD, presented with diffuse bilateral lung infiltrations. However, despite the rapid development of respiratory failure, the patient had a better response and outcome to steroid therapy than what would be expected for DAD.

Home Telemetric System for Pulmonary Function Surveillance: A Useful Procedure for Detection of Late-Onset Noninfectious Pulmonary Complications (LONIPC) after Allogeneic Hematopoietic Stem Cell Transplantation (HSCT).

Late-onset noninfectious pulmonary complications (LONIPC) of allogeneic hematopoïetic stem cell transplantation (HSCT) occur in 2 to 25% of recipients. LONIPC include bronchiolitis obliterans (BrOb), which is associated with an obstructive syndrome, bronchiolitis obliterans with organizing pneumonia (BOOP) and interstitial pneumonia (IP), which are associated with a restrictive syndrome on pulmonary function tests. LONIPC have poor prognosis with death from respiratory failure in more than 30% of cases. We evaluated a telemetric system for home pulmonary function surveillance, for early diagnosis and treatment of LONIPC in allogeneic HSCT recipients.We conducted a prospective study of 35 patients living in Paris area, who survived over 3 months after HSCT (median age 46 years, myeloablative conditioning regimen in 54.2% of patients, HLA-identical sibling donor in 65.7%) between June 2001 and January 2004. Three months after HSCT, patients were delivered a portable spirometer (Spirotel®, M-Elect France), measuring vital capacity, forced expiratory volume per second, and mid expiratory flow 25 to 75 values. Data were transmitted by phone to hospital twice a week. If significant deterioration (>20%) was confirmed by plethysmography, then patients were admitted in Pneumology Department.Thirteen episodes of spirometric deterioration were detected in 11 patients during a median follow-up period of 18 months (1 to 42). LONIPC was diagnosed on spirometric, CT scan and broncho-alveolar lavage criteria during 8 episodes in 7/35 patients (20%), occurring after a median time of 11 months (6 to 18) after HSCT. One of these 7 patients had previously developed acute graft versus host disease (GVHD) and 5 had current chronic GVHD. LONIPC were BrOb, (n=3), interstitial pneumonia (n=4), or both BrOb and interstitial pneumonia (n=1). Patients were treated with increasing immunosuppressive regimens (prednisone and/or, mycophenolate mofetil, and/or cyclosporine A). Five patients improved and 2 were stabilised. There was no case of long-term oxygen therapy or death from respiratory failure (median follow-up 24 months (12 to 34) from LONIPC diagnosis). Telemetric home monitoring of pulmonary function is a reliable procedure easy-to-use for early diagnosis of LONIPC, which might improve the usual severe prognosis of LONIPC occurring after allogeneic HSCT.

Unusual Complication after Radiotherapy for Breast Cancer Bronchiolitis Obliterans Organizing Pneumonia Case Report and Review of the Literature

Breast-conserving surgery and postoperative radiotherapy play an important role in the treatment of early breast cancer. Bronchiolitis obliterans with organizing pneumonia (BOOP) is an uncommon syndrome reported to be one of the complications of adjuvant radiotherapy. We report the case of a 71-year-old woman who developed cough, dyspnea and fever three weeks after radiation therapy to the left breast for breast carcinoma. Chest X-ray and computed tomography scan demonstrated alveolar opacities within both lungs. Antibiotic therapy against any probable septic pathology did not improve the symptoms, while corticosteroid treatment resulted in rapid clinical improvement together with regression of the pulmonary opacities. Irradiation was thought to be the cause of the migratory pneumonitis, hence this case was clinically diagnosed as radiation-induced migratory pneumonitis similar to BOOP, without lung biopsy. The present case suggests that one should be mindful of this disease when treating patients with a history of irradiation to the breast. BOOP promptly responds to systemic corticosteroid therapy with rapid improvement of symptoms and regression of the pulmonary opacities.