Diagnosis Of Bronchiolitis Obliterans Organizing Pneumonia Research Articles

A Case of Dermatomyositis Causing Cryptogenic Organizing Pneumonia

Cryptogenic organizing pneumonia (COP), also known as idiopathic bronchiolitis obliterans organizing pneumonia (BOOP), is a rare inflammatory condition. It often presents as sequelae of existing chronic inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, and various connective tissue conditions. This case describes a 28-year-old African American female who presented with a complex clinical picture involving chronic inflammatory processes and the pulmonary system. The initial evaluation suggested pneumonia to be the underlying cause of respiratory symptoms; however, ultimately, a diagnosis of BOOP with dermatomyositis was made.

Unusual Presentation of Bronchiolitis Obliterans Organizing Pneumonia Mimicked Pulmonary Metastases: A Case Report

SESSION TITLE: Imaging SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: The radiological presentation of bronchiolitis obliterans organizing pneumonia (BOOP) is characterized by multiple air space consolidations with a subpleural distribution or areas of ground glass lung infiltration. We report a case of BOOP presenting with a multiple nodular pattern mimicking miliary metastasis lung infiltration. CASE PRESENTATION: A 47-year-old man presented with cough. He was a current smoker for 35 years. He had COPD and DM. Vital signs were normal. Chest X-ray showed bilateral nodular opacities. Thorax computed tomography; predominantly in the upper lobe, bilateral, multiple pulmonary nodules (the largest 20 mm) with variable border features were detected, some of which were frosted glass densities (Fig.1). Mediastinal (10 mm in diameter), right suprahiler (15 mm in diameter) and both axillar lymph nodes were present. Serological tests were normal. Mycobacterium tuberculosis was negative. PET/CT: Several millimetric lymph nodes without mediastinal pathologic FDG involvement were observed. A large number of nodules were observed in both lung parenchyma, some of which were calcified, with mildly elevated FDG uptake (Early SUV max: 2,18, Late SUV max: 3,14) (Fig.1). Lung biopsies with wedge resection were perfomed under video-assisted thoracoscopy(VATS). Histopathological analysis consistented with BOOP (Fig.2). The patient underwent steroid therapy at a dose of 48 mg / day with the diagnosis of BOOP. At 3 months of treatment, control CT completely removed. The steroid treatment was stopped at 4 months because of uncontrolled diabetes mellitus. The patient was followed-up for one year, and the disease did not relapse. DISCUSSION: Heterogenic radiologic features on X-ray and on CT scan make correct diagnosis difficult, sometimes resulting in ineffective therapy and unnecessary hospitalization. Most often, CT scan shows unilateral or bilateral airspace consolidation with a predominantly peripheral distribution in lower and middle zones. Contrary to the common radiological findings in our case, there were bilateral multifocal nodules with predominantly upper lobes. In pet ct; metastatic disease can not be excluded due to increased metabolic activity in late images. Therefore, histopathological confirmation is required. We did not find any reports that bronchiolitis obliterans organized pneumonia pet ct findings. It may be said that boop pet ct findings may interfere with malignancy. CONCLUSIONS: In conclusion, our patient had an unusual radiological pattern of bilateral pulmonary nodules associated with COP that mimicked pulmonary metastases. Its radiological and nuclear properties can lead to misdiagnosis like malignancy. Reference #1: American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med. 2002;165:277-304. DISCLOSURE: The following authors have nothing to disclose: Demet Polat, Eylem Ozgur, Sibel Atis Nayci, Tuba Kara, Feramuz Apaydin, Pelin Özcan No Product/Research Disclosure Information

Bronchiolitis Obliterans Organizing Pneumonia as an Initial Presentation of Systemic Lupus Erythematosus: A Rare Case Report and Literature Review.

The etiology of bronchiolitis obliterans organizing pneumonia (BOOP) remains controversial. While it has been reportedly associated with several connective tissue disorders, there are only rare reports of BOOP associated with systemic lupus erythematosus (SLE). Herein, we report a 56-year-old female patient who presented with dyspnea on exertion, cough, fever, and joint pain of her left wrist and fingers as initial symptoms. Laboratory tests revealed positivity for anti-nuclear antibody, anti-Ro, and anti-double strand DNA antibody. In this case, the patient with SLE had respiratory illness as the initial symptom due to BOOP in the absence of clear etiology. The diagnosis of BOOP was confirmed by thoracic surgery biopsy. Her respiratory symptoms and radiologic findings significantly improved following prednisolone treatment.

Abstract P5-11-02: Breast Cancer Radiation Therapy and the Risk of Developing Bronchiolitis Obliterans Organizing Pneumonia (BOOP): Communication of BOOP Risk by Breast Cancer Information Websites and General Medical Information Websites

Abstract Background: BOOP is an inflammatory pulmonary disorder consisting of organized polypoid granulation tissue in the distal airways extending into the alveolar ducts and alveoli. Clinical manifestations of BOOP include fever, cough, dyspnea on exertion, and fatigue. Patients with severe BOOP require hospitalization. The mainstay of BOOP treatment is high dose corticosteroids. Many patients relapse and require long term corticosteroids, often in combination with another immunosuppressant. Significant morbidity and disability may be associated with both the diagnosis of BOOP and the toxicities of treatment. The mortality rate of BOOP has been estimated to be about 5%. Radiation Therapy (RT) is an important component in the treatment of breast cancer (Breast Ca). Beginning in 1995, reports of BOOP occurring in Breast Ca RT patients began to appear in the medical literature. From 1995 to the present, 43 case study reports described 121 Breast Ca RT patients who developed BOOP within one year of their RT. From 1999 to 2011, seven epidemiological studies were published that suggested that the incidence of BOOP in Breast Ca RT patients was in the range of 2% to 3%. Objectives: The primary objective of this study was to determine if internet sources of Breast Ca information targeted to Breast Ca patients include BOOP information in their description of RT risks. The secondary objective was to determine if general medical websites conveyed BOOP/Breast Ca RT risk information. Methods: Eight websites specifically targeted to Breast Ca patients were reviewed. Sponsors of these websites included the US government, Breast Ca advocacy groups, and medical organizations. Seven general medical websites that contained BOOP/Breast Ca RT information were also reviewed. Results: There was no mention of BOOP in any of the websites targeted to Breast Ca patients. The websites included those from the National Cancer Institute, American Cancer Society, American Society of Therapeutic Radiology and Oncology, Susan G. Komen, and BreastCancer.org. The internet search identified seven general medical websites that did include information about the risk of BOOP from Breast Ca RT. Discussion: It is perplexing that none of the eight website sources for Breast Ca patients included any mention of the risk of BOOP associated with Breast Ca RT, whereas seven general medical internet sources did disclose this information. This disparity raises important issues and questions. The majority of BOOP/Breast Ca RT reports were published in pulmonology journals. Is this information being disseminated to providers of Breast Ca treatment? Many of the Breast Ca information websites stated that their information was up to date and was reviewed by leading Breast Ca physicians, so it remains an enigma that the BOOP/RT association was not disclosed. The lack of any information about BOOP and Breast Ca RT may indicate Breast Ca physician unawareness. An alternative explanation for this finding may be that these physicans are aware of the BOOP/RT association, but they believe that the rarity of BOOP diagnoses justifies omitting this information in internet-based information sources. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-11-02.

BALF cell findings in patients with BOOP, particularly in comparison with UIP

It is possible to differentiate to some degree to bronchiolitis obliterans organizing pneumonia (BOOP) of unknown etiology from idiopathic usual interstitial pneumonia (UIP) on the basis of clinical symptoms, chest X-ray findings, pulmonary function test and blood gas findings, but in certain patients it can be difficult. Cell findings in bronchoalveolar lavage fluids (BALF) were compared between 8 patients with BOOP and 28 patients with UIP, both diagnosed histologically by open lung biopsy. Findings characteristic of BOOP included (1) an increase in the percentage of lymphocytes, (2) an increase in the percentage of eosinophils, and (3) a decrease in the OKT4+/OKT8+ ratio. These findings provide useful information in making a clinical diagnosis of BOOP and in evaluating proper steroid treatment in patients who unable to undergo open lung biopsy.

Pulmonary nodular lesions in a 70-year-old man

Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon but increasingly recognized clinicopathologic syndrome. This report illustrates a proteiform clinical presentation of BOOP in a 70-year-old patient with cough, low-grade fever, weight loss, and hemoptysis. Chest radiograph and computed tomography (CT scan) showed nodular lesions. A video-assisted thoracoscopic procedure for biopsy of the largest nodule was performed at the end of an extensive work-up. A diagnosis of BOOP was established and, because of persistent symptomatology, corticosteroid therapy was initiated. This observation illustrates that the clinical and radiological findings of BOOP are non-specific and can sometimes mimic primary and/or secondary pulmonary malignancies.

Bronchiolitis obliterans organizing pneumonia (BOOP) with suspected liver graft-versus-host disease after allogeneic bone marrow transplantation

Abstract We report on a patient with chronic myelogenous leukemia who developed bronchiolitis obliterans organizing pneumonia (BOOP) after allogeneic bone marrow transplantation (BMT). A 19-year-old Japanese male complained of dry cough and dyspnea 7 months after BMT. The chest X-ray and computed tomography revealed patchy infiltrates bilaterally. Lung function test, lung biopsy and bronchoalveolar lavage were consistent with the diagnosis of BOOP. The patient also suffered from suspected graft-versus-host disease (GVHD) of the liver, after discontinuation of cyclosporine. Furthermore, prednisolone proved effective against the BOOP and the liver dysfunction. These findings indicate that BOOP is a possible pulmonary manifestation of chronic GVHD, and that immunological mechanisms may have effected the onset of BOOP after BMT in this case.

Bronchiolitis Obliterans Organizing Pneumonia Associated with AcuteMycoplasma pneumoniaeInfection

A patient with bronchiolitis obliterans organizing pneumonia (BOOP) associated with acute Mycoplasma pneumoniae infection is described. Although mycoplasmas have occasionally been associated with bronchiolitis obliterans, to the best of our knowledge, this is the first well-documented case of BOOP associated with M. pneumoniae infection. The diagnosis of BOOP was made by open-lung biopsy after fiberoptic transbronchial biopsy proved nondiagnostic. Corticosteroid therapy was administered and a dramatic improvement was observed; the patient remained without complaints during a 3-year follow-up period.

Bronchiolitis Obliterans Organizing Pneumonia: Diagnosis by Transbronchial Biopsy

Transbronchial biopsy (TBB) has been considered to be inadequate for the diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). We describe herein two patients with interstitial pulmonary disease in whom the diagnosis of BOOP was achieved by TBB. The two patients presented with progressive dyspnea, cough, tachypnea, and fine end-inspiratory crackles. The radiologic findings disclosed patchy alveolar infiltrates. Pulmonary function tests showed a restrictive pattern and decreased diffusing capacity. The pathologic findings disclosed bronchioles, alveolar ducts, and alveoli infiltrated with mononuclear cells. The lumina were obliterated with fibroblasts and loose granulation tissue. Corticosteroid treatment resulted in significant improvement. Transbronchial biopsy should be considered as a useful diagnostic tool for BOOP.