Bronchiolitis Obliterans Organizing Pneumonia Research Articles

A SEVERE CASE OF ORGANIZING PNEUMONIA FROM VAPING AND COCAINE USE

A SEVERE CASE OF ORGANIZING PNEUMONIA FROM VAPING AND COCAINE USE

CRYPTOGENIC ORGANIZING PNEUMONIA: A DIAGNOSTIC DILEMMA IN A WORLD DOMINATED BY COVID-19 PNEUMONIA

CRYPTOGENIC ORGANIZING PNEUMONIA: A DIAGNOSTIC DILEMMA IN A WORLD DOMINATED BY COVID-19 PNEUMONIA

A CASE OF SECONDARY ORGANIZING PNEUMONIA FROM INFLIXIMAB

A CASE OF SECONDARY ORGANIZING PNEUMONIA FROM INFLIXIMAB

WHEN LUNG BECOMES BONE: A RARE CASE OF DENDRIFORM PULMONARY OSSIFICATION

WHEN LUNG BECOMES BONE: A RARE CASE OF DENDRIFORM PULMONARY OSSIFICATION

Unusual cause of bronchiolitis obliterans in an immunosuppressed patient

Abstract Bronchiolitis obliterans organizing pneumonia (BOOP) is a diffuse interstitial lung disease, currently classified as cryptogenic organizing pneumonia (COP) when idiopathic, respectively organizing pneumonia (OP) in case of a specified etiology. We present the case of a 48-year-old patient, former smoker (20PY), diabetic, who accused moderate dyspnea, persistent febrile syndrome. The chest radiography showed multiple areas of condensation distributed bilaterally diffusely and the laboratory data revealed an important inflammatory syndrome. More than 100 colonies of Candida albicans were isolated from the sputum, therefore antifungal therapy was initiated. The computer tomography scan (CT scan) highlighted multiple micronodular and nodular lesions, some with tendency of excavation and hydroaeric level present and a polyseptate lesion in the right lower lobe; no proliferative elements were found during bronchoscopy and the bronchoalveolar lavage was non-specific; To obtain a final diagnosis, a CT-guided transthoracic needle biopsy was performed and the histological examination was compatible with organized pneumonia.

Neumonías intersticiales idiopáticas

Idiopathic interstitial fibrosis has nonspecific, insidious clinical symptoms; it is the most common interstitial disease and has the worse known prognosis, with a survival without treatment of two to five years. In 2018, scientific societies updated the diagnostic criteria; the presence of a usual interstitial pneumonia pattern on an HRCT scan and/or a lung biopsy are decisive for establishing a diagnosis. Among idiopathic interstitial pneumonias, the most common is pulmonary fibrosis, but there are other less common entities such as nonspecific interstitial pneumonia (NSIP), respiratory bronchiolitis-associated diffuse interstitial lung disease (RB-DILD), and desquamative interstitial pneumonia (DIP); the latter two are related to tobacco use. There are also those which present in acute or subacute forms, such as cryptogenic organizing pneumonia (COP) and acute interstitial pneumonia (AIP). Lastly, there are the least common forms, such as lymphoid interstitial pneumonia (LIP) and idiopathic pleuroparenchymal fibroelastosis (IPPFE).

P204 Secondary organizing pneumonia caused by Aspergillus flavus in immunocompromised patients

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIntroductionFungal pneumonia is a known complication in immunocompromised patients. However fungal infection leading to organizing pneumonia (OP) is a rare entity. Here we present two cases of co-occurrence of OP with Aspergillus lung infectionCase 1: A 33-year-old male with a history of recurrent oral-genital ulcerations and low-grade fever for the last 3 months presented with shortness of breath and high-grade fever for 10 days. On presentation he was hypotensive, tachycardic, and tachypneic, examination revealed bilateral crackles. His initial investigations were hemoglobin (Hb) 8.8, total leucocyte counts (TLC) 13 000, platelet 190 000, liver function test (LFT), and kidney function test (KFT) were normal. High-resolution commuted tomography (HRCT) revealed multifocal areas of interlobular septal thickening with ground glass opacity and patchy areas of consolidation seen in bilateral lung fields (Fig. 1). He was initially managed with broad-spectrum antibiotics and oxygen support by a high flow nasal cannula (HFNC); as the condition deteriorated, he was mechanically ventilated. Fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) was performed. Investigations for tuberculosis, nocardia, pneumocystis carinii, and bacterial infection in BAL was negative. Galactomannan index (GMI) in BAL was 3.15 and grew Aspergillus flavus. Transbronchial biopsy revealed features consistent with organizing pneumonia. He was started on voriconazole and steroids. He was diagnosed with undifferentiated connective tissue disorder. As the patient's condition improved in due course of time, he was extubated and discharged in stable condition on voriconazole and steroids and is currently doing fine.Case 2: A 56-year-old male known case of mantle cell lymphoma on consolidation therapy, presented with 15 days history of shortness of breath and high-grade fever. Chest examination revealed decreased breath sounds bilaterally in the lower lung zones with lower zone crackles. Initial investigations showed Hb 10.9, TLC 3.90, platelet 150000, KFT and LFT were normal. HRCT scan revealed multilobular areas of consolidation showing air bronchogram with ground glass opacities in bilateral lung (Fig. 1). Bronchoalveolar lavage fluid (BALF) revealed the growth of Aspergillus flavus and was GMI 1.97. Investigations for tuberculosis, nocardia, pneumocystis carinii and bacterial infection was negative. Transbronchial biopsy revealed features consistent with organizing pneumonia. He was started on combination therapy with voriconazole and micafungin along with steroids. Initially, he was managed with oxygen support but his oxygenation gradually worsened, he was mechanically ventilated, and received multiple pruning sessions. Patient had refractory organizing pneumonia, did not show any improvement even after 1 month, and left against medical advice.ConclusionBacterial and viral infections are the common causes of secondary OP. Fungal infections implicated in secondary OP are rarely described, of which there are reports of Pneumocystis jiroveci (PJP) and Penicillium infection leading to secondary OP. Aspergillus flavus is a ubiquitous fungal agent and is considered as pathogenic in immunocompromised settings can lead to secondary organizing pneumonia. High index of suspicious for OP is always to be kept in mind while treating Aspergillus flavus pneumonia.

Clinical characteristics of 6 children with idiopathic interstitial pneumonia

Objective: To analyze the clinical characteristics and prognosis of 6 children with idiopathic interstitial pneumonia (IIP). Methods: This retrospective study analyzed the clinical manifestations, examinations, treatment and prognosis of 6 children with IIP who were hospitalized in Children's Hospital of Nanjing Medical University from January 2015 to March 2020. Results: Of the 6 children, 2 were males and 4 were females, aged 4.8 to10.6 years. All children had a subacute onset, and presented with cough, shortness of breath and cyanosis. The lung high-resolution CT (HRCT) showed diffuse patchiness in bilateral lung fields in all the children and reticular pattern in 2 cases. Pulmonary function test found moderate to severe mixed defect in 5 children. Lung biopsy was performed in 4 children. All of the 6 children were treated with systemic glucocorticoids, of whom 2 cases had additional inhaled glucocorticoids. Four children were finally diagnosed as cryptogenic organizing pneumonia (COP), whose lung HRCT return to normal in 1-11 months. Two children were finally diagnosed as nonspecific interstitial pneumonia (NSIP), and had long-term residual fibrosis on lung HRCT. The 6 children were followed up for 1 year to 6 years and 5 months after discontinuation of systemic glucocorticoids, and all had no recurrence. Conclusions: The clinical characteristics of IIP in children are subacute onset presented with cough, shortness of breath, cyanosis and diffuse patchiness in bilateral lungs on HRCT. The common subtypes of IIP in children are COP and NSIP. Systemic glucocorticoid is effective for IIP in children and there is a good prognosis overall.

Clinical features of organizing pneumonia in anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders

Anti-aquaporin-4 (AQP4) antibody is an autoantibody marker often observed in patients with neuromyelitis optica spectrum disorder (NMOSD). The pathological relevance of complicated pulmonary disorders in anti-AQP4 antibody-positive NMOSD remains unclear. We aimed to assess the clinical and histological relevance of complicated pulmonary disorders in anti-AQP4 antibody-positive NMOSD. We retrospectively reviewed the medical records of 52 patients with anti-AQP4 antibody-positive NMOSD and conducted immunohistochemical evaluations of the lung biopsy specimens. Among 52 patients with anti-AQP4 antibody-positive NMOSD, 4 patients showed pulmonary involvement with a diagnosis of organizing pneumonia (OP). The proportion of males was larger (75% vs. 12.5%; p=0.013) and creatine kinase levels were higher (458.3 U/L vs. 83.9 U/L; p=0.003) in patients with OP than in those without OP. OP development preceded or coincided with the NMOSD symptoms. Chest computed tomography findings were consistent with OP in all four patients. Bronchoalveolar lavage fluid predominantly contained lymphocytes. Transbronchial lung biopsy revealed intraluminal plugs of inflammatory debris within the alveoli. Alveolar epithelial cells covering the OP lesions exhibited AQP4 loss, immunoglobulin G deposition, and complement activation. Corticosteroid treatment resulted in clinical improvement of OP. OP may be considered a pulmonary manifestation of anti-AQP4 antibody-positive NMOSD beyond the central nervous system. Complement-dependent cytotoxicity of the lung epithelial cells caused by anti-AQP4 antibody is at least partly involved in OP development. When diagnosing NMOSD, the possibility of OP should be carefully evaluated based on the detailed history and chest imaging findings.

Influence of radiologic pattern and the presence of diffuse parenchymal lung disease on outcome in ventilated patients with COVID-19 pneumonia: impact on prognosis.

BackgroundSuspected organising pneumonia (OP) is a common finding in patients with severe coronavirus disease 2019 (COVID‐19), but the impact on outcomes of the radiological patterns of diffuse parenchymal lung disease on outcome of these patients is still uncertain.AimsInvestigate the presence of radiological images compatible with OP and its association with clinical outcomes in patients with COVID‐19 submitted to invasive mechanical ventilation (IMV).MethodsRetrospective, unicentric cohort study composed of patients who required IMV and underwent chest computerized tomography to investigate secondary complications of COVID‐19. We compared patients with radiological findings characteristic of suspected OP with those without this condition. The main outcome was hospital mortality.ResultsTwo hundred and ten patients were included, and 65 had signals compatible with OP. All patients with suspected OP were treated with corticosteroids. There was no difference in IVM‐free days until day 28 between the groups (median, 0 days; interquartile range [IQR], 0–14.8) in the group with suspected OP vs 0 days (IQR, 0–11) in the group without suspected OP (P = 0.14). In univariate analysis, the presence of suspected OP was associated with lower hospital mortality; however, after correction for potential confounding variables, it was not associated with the outcome, even after matching by propensity score in patients without this condition.ConclusionOP radiologic pattern in patients with severe COVID‐19 is not associated with worse outcomes.

Cryptogenic organized pneumonia: Case report and literature review

Introduction: cryptogenic organized pneumonia is a clinical, radiological and histological entity classified as interstitial lung disease. Case Report: A 40 year old man had initially consulted for influenza-like syndrome. Our clinical examination founded dry crackling rails in bilateral lungs , the tomography showed condensation fireplace and bilateral ground glass fireplaces in relation to the condensing foci seat by place of sub-pleural cross-linkings achieving an aspect of crazy paving, ground glass fireplace surrounded by condensation achieving the aspect of inverted halo. The patient was initially treated as bacterial pneumonia but without improvement under multiple antibiotic therapies. Bronchoscopy had objectified an endoscopic appearance without particularity. The etiological assessment was negative. The diagnosis of cryptogenic organized pneumonitis in its was retained. Systemic corticosteroid therapy was prescribed and the assessment at 3 months, 5 months of treatment had noted a clear and frank improvement clinically and radiologically with a relapse at the 9 Th month following the stop a corticosteroid therapy. Discussion: Cryptogenic Organizing Pneumonia, was recently defined by an ATS/ERS consensus conference. Diagnosis is established by combining clinical, radiological and histological criteria. Most patients respond well to corticosteroid therapy. Relapses are frequent but can generally be controlled with moderate doses of prednisone. Conclusion: POC has become a well-characterized entity among idiopathic interstitial lung diseases. It is characterized by a usual clinic-radiological presentation, often with a good prognosis and their management requires a multidisciplinary approach.

Cryptogenic organized pneumonia: Case report and literature review

Cryptogenic organized pneumonia: Case report and literature review

Can Ultrasound and Contrast-Enhanced Ultrasound Help Differentiate between Subpleural Focal Organizing Pneumonia and Primary Lung Malignancy?

Background: Subpleural focal organizing pneumonia (FOP) and primary lung malignancy (PLM) are usually confused. The aim of this study was to explore the value of ultrasound (US) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of FOP and PLM. Methods: A total of 23 patients (mean age: 64.57 ± 11.86 years) with FOP and 100 (mean age: 66.29 ± 11.05 years) with subpleural lesions diagnosed as PLM, confirmed by pathological diagnosis and clinical follow-up, were retrospectively enrolled. The largest lesion diameter, angle between the lesion border and thoracic wall, air bronchial sign, internal blood supply, blood supply form, and pleural effusion examined using conventional US were retrospectively analyzed. The indicators of CEUS included the arrival time of contrast agent in the lesion, lesion–lung arrival time difference, degree of enhancement, distribution uniformity of contrast medium, presence of non-enhancing region, and arterial filling mode in the lesion. A p < 0.05 was considered statistically significant. Results: Presence of air bronchial sign (odds ratio [OR] = 6.18, p = 0.025), acute angle between the lesion border and thoracic wall (OR = 7.124, p = 0.033), and homogeneous enhancement (OR = 35.26, p = 0.01) showed predictive value for the diagnosis of FOP. According to the results of the logistic regression analysis, the area under the receiver operating curve of the above features combined was 0.960, and the sensitivity and specificity were 95.0% and 82.6%, respectively. Conclusions: US combined with CEUS has the potential to differentiate between FOP and PLM.

Immune check-point inhibitor-related pneumonitis: acute lung injury with rapid progression and organising pneumonia with less severe clinical disease.

To improve understanding of the pathology of immune check-point inhibitor (ICI)-related pneumonitis, clinical, radiographic and histopathological features and outcomes were investigated in a cohort of patients who were treatment-naive before receiving ICI inhibition, who underwent lung biopsy, and in whom other potential causes of lung injury were excluded. Patients were retrospectively identified via searches of institutional pathology and clinical records. Patients treated with other modalities for cancer and patients with lung infections or other aetiologies that could cause pneumonitis were excluded. Clinical records were reviewed by pulmonologists. Imaging studies at presentation and follow-up were reviewed by a thoracic radiologist. Pathology was reviewed by thoracic pathologists. Six patients with ICI-related pneumonitis were identified. Two patients presented with respiratory failure requiring mechanical ventilation, diffuse ground glass opacities (GGOs) on chest computed tomography (CT) and acute lung injury (ALI) pattern on transbronchial lung biopsies and had fatal outcomes, despite treatment. The remaining four patients presented with less severe symptoms, predominantly consolidations and patchy ground glass and part solid opacities on chest CT, organising pneumonia (OP) or chronic interstitial inflammation histologically, and showed favourable responses to treatment and remission within months. This study highlights two radiological-pathological patterns of ICI-related pneumonitis with different behaviour: (1) severe respiratory symptoms and diffuse GGOs on imaging correlating with ALI pattern histologically and poor prognosis; and (2) mild respiratory symptoms and consolidations or patchy subsolid opacities on imaging correlating histologically with OP or chronic interstitial inflammation and good outcomes.

IL-9 and IL-9 receptor expression in lymphocytes from bronchoalveolar lavage fluid of patients with interstitial lung disease

IntroductionIL-9, mainly produced by T helper 9 (Th9) cells, promotes allergic airway inflammation and remodeling through the interaction with its receptor (IL-9R). Th9 cells and IL-9 have also been implicated in tissue fibrosis and autoimmunity pathways. However, the role of IL-9/IL-9R in the pathogenesis of interstitial lung disease (ILD) is unknown. AimTo evaluate IL-9/IL-9R expression in bronchoalveolar lavage fluid (BALF) lymphocytes of patients with various ILDs. MethodsConsecutive patients with ILD, who underwent BAL for diagnostic purposes, were studied. As control group, consecutive patients without evidence of ILD were included. Immunocytochemical staining of BALF lymphocytes for IL-9 and IL-9R was performed and evaluated by two independent readers. Results45 patients, of them 8 had idiopathic pulmonary fibrosis (IPF), 12 nonspecific interstitial pneumonia (NSIP), 10 sarcoidosis, 9 hypersensitivity pneumonitis (HP), 6 cryptogenic organizing pneumonia (COP), and 24 controls were studied. In the ILD group, the highest BALF lymphocyte count was seen in HP followed by NSIP, COP, sarcoidosis, and IPF (p < 0.05 for HP vs IPF). The highest percentages of IL-9 and IL-9R positive lymphocytes were seen in COP. Conversely, NSIP showed the lowest rate of IL-9, and sarcoidosis the lowest rate of IL-9R positive lymphocytes. Only in NSIP, a direct correlation between IL and 9 and IL-9R positive lymphocytes was seen (r = 0.639, p = 0.025). ConclusionBALF lymphocytes IL-9 and IL-9R expression differs between various ILDs and could reflect different pathogenetic mechanisms.

Increased Interleukin-17 and Glucocorticoid Receptor-β Expression in Interstitial Lung Diseases and Corticosteroid Insensitivity.

BackgroundTreatment responsiveness to corticosteroids is excellent for cryptogenic organizing pneumonia (COP) and sarcoidosis, but suboptimal for idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP). We hypothesise that the differential expression of IL-17 contributes to variable corticosteroid sensitivity in different interstitial lung diseases.ObjectiveTo determine the associations among expression of IL-17, glucocorticoid receptor-β and responsiveness to corticosteroid treatment in interstitial lung diseases.MethodsImmunohistochemical (IHC) staining was performed on formalin-fixed paraffin-embedded (FFPE) lung tissues obtained by bronchoscopic, CT-guided or surgical biopsies, and quantified by both cell counting (% positive cells) by individuals and by software IHC Profiler plugin of ImageJ (opacity density score). We studied the effect of IL-17 on corticosteroid sensitivity in human fibroblast MRC5 cell line.ResultsCompared with specimens from patients with COP (n =13) and sarcoidosis (n =13), those from IPF patients (n = 21) had greater GR-β and IL-17 expression and neutrophil infiltration. Radiographic progression after oral corticosteroid treatment was positively correlated with the expression in IL-17 and GR-β/GR-α ratio in all patients (COP, sarcoidosis and IPF) and also within the IPF subgroup only. IL-17 expression level was positively associated with GR-β and GR-β/GR-α ratio. In MRC5 cells, exogenous IL-17 increased the production of collagen I and up-regulated GR-β expression and dexamethasone’s suppressive effect on collagen I production was impaired by IL-17, and silencing IL-17 receptor A gene attenuated the effect of IL-17.ConclusionUp-regulation of GR-β/GR-α ratio by IL-17 could be associated with the relative corticosteroid-insensitivity of IPF.

Rheumatoid arthritis overlapping systemic sclerosis with interstitial lung disease

Lung disease is the second most frequent extra articular manifestation in rheumatoid arthritis (RA) patients. It can be present in up to 80% RA cases and represents a major cause of morbidity and mortality. One of the most common types of lung involvement in RA patients is the interstitial lung disease (ILD). Computed tomography studies show evidence of ILD in a large proportion of patients with RA (over 50% in some studies) and it can be clinically symptomatic in 5% of cases. The CT aspect classifies four forms of ILD, listed in order of frequency: usual interstitial pneumonia (UIP) - the most common form, non-specific interstitial pneumonia (NSIP), organizing pneumonia (OP) and diffuse alveolar damage (DAD) which is the least common form. We present a long-standing case of rheumatoid arthritis overlapping systemic sclerosis with interstitial lung disease.

Secondary Organising Pneumonia Among COVID-19 Patients: A Retrospective Case-Control Study.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Secondary organising pneumonia (OP) induced by SARS-CoV-2 infection is a recently recognised complication of COVID-19. We aimed to evaluate the prevalence of OP among hospitalised patients with COVID-19 pneumonia and to assess whether disease severity and other clinical factors and comorbidities are correlated with OP development.We conducted a retrospective case-control study including hospitalised patients due to COVID-19 who performed a chest CT scan during hospitalisation and compared patients with clinical and radiological evidence of OP to patients without evidence of OP. Demographics, comorbidities, disease severity, dexamethasone/remdesivir treatment, laboratory results, and outcomes were compared between groups.One hundred fifteen patients were included, of whom 48 (41.7%) fulfilled clinical and imaging criteria for OP. Among OP patients, the most common chest CT-scan findings were consolidations, arciform condensations, and subpleural bands. OP patients had longer hospitalisation (19.5 vs 10 days, p=0.002) and more frequent ICU admission, but no significant differences in readmittance or mortality rates within 180 days compared to controls. In the adjusted effects model, the need for supplementary oxygen on the 21st day after symptom onset, the presence of Ordinal Scale for Clinical Improvement (OSCI) = 4, when compared to OSCI ≤ 3, and higher C-reactive protein on admission, were significantly associated with higher odds for OP. No other differences were identified between OP and controls after adjusting for other factors. The use of remdesivir or dexamethasone did not impact the diagnosis of OP. Only 38% of OP patients required treatment with high-dose corticosteroids.In conclusion, SARS-CoV-2-induced OP may be more frequent than previously thought, especially among hospitalised patients and patients with a more severe disease, particularly those who fail to improve after the second week of disease or who present higher inflammatory markers on admission. It increases the length of stay, but not all patients require specific treatment and OP may improve despite the absence of high-dose corticosteroid treatment.

The many faces of cryptogenic organizing pneumonia (COP).

Organizing pneumonia (OP) is interstitial pneumonia with an acute or subacute clinical course and a histological pattern compatible with acute lung injury. It usually arises after a recent infection of the peripheral bronchial system, whereby is called secondary OP. However, often OP arises with no recognizable cause for which it is called cryptogenic organizing pneumonia (COP). From a radiological standpoint, COP exhibits different imaging appearances and this review makes radiologists and clinicians familiar with the entire spectrum of expected disease findings. Successful interpretation of imaging is pertinent for a rapid diagnosis of COP and knowledge of the entire spectrum of imaging findings in COP is mandatory.

ORGANIZING PNEUMONIA AS A SIDE EFFECT OF COVID-19 VACCINE

TYPE: Case Report TOPIC: Diffuse Lung Disease INTRODUCTION: Comprehensive side effects of Coronavirus disease 2019 (COVID-19) vaccine are still unknown. Here we report the case of organizing pneumonia (OP) post COVID-19 vaccination. CASE PRESENTATION: A 73-year-old male with past medical history of hypertension presents with shortness of breath, cough, low-grade fever, generalized weakness and decreased appetite for one week. Patient had received second dose of COVID-19 vaccination 2 months prior. Physical examination revealed bilateral crepitations. Patient was hypoxic requiring supplemental oxygen. COVID-19 PCR and rapid antigen test (x 2) were negative. Computed tomography showed extensive bilateral ground glass infiltrates and some interstitial septal thickening with nodular infiltrates. Patient was started on broad spectrum antibiotics. Multiple transbronchial biopsies collected from different sites showed findings consistent with typical organizing pneumonia. Further infectious, immunologic, rheumatologic and vasculitis work-up to look for underlying cause of OP was negative. DISCUSSION: OP is a histopathological condition in which bronchioles, alveoli and walls of small bronchi become inflamed and get occupied with buds of granulation tissue progressing from fibrin exudates to loose collagen containing fibroblasts. It has varied radiologic manifestations. In addition to cryptogenic organizing pneumonia, it can be seen in vasculitis, bronchocentric granulomatosis, chronic eosinophilic pneumonia, hypersensitivity pneumonia, diffuse alveolar damage, non-specific pneumonia, lung abscess, pulmonary infarct and cancers. Secondary OP can be caused secondary to heart-lung transplantation, bone-marrow transplantation, infections, acute respiratory distress syndrome, drug use, radiotherapy, connective tissue diseases and aspiration pneumonia. CONCLUSIONS: As this being the first reported case of post COVID-19 vaccine related OP, further studies and data is required to establish causative relationship. DISCLOSURE: Nothing to declare. KEYWORD: Coronavirus disease 2019 vaccine