Acute fibrinous and organizing pneumonia associated with influenza A/H1N1 pneumonia after lung transplantation

Abstract

BackgroundImmunocompromised patients, particularly after lung transplantation, are at high risk to develop atypical forms of pulmonary infections including influenza A/H1N1. Acute Fibrinous and Organizing Pneumonia (AFOP) is a special histological pattern in acute respiratory failure with high mortality.Case presentationWe describe a 66-year-old woman with double lung transplantation in August 2009 due to end stage pulmonary fibrosis. After prolonged weaning and subsequent promising course, she developed atypical pneumonia with diffuse pulmonary infiltrates in both lungs in January 2010. Infection with influenza A/H1N1 virus was verified. The patient rapidly suffered from respiratory insufficiency and died eight days after this diagnosis. The post-mortem revealed especially in the lower parts of the lungs the classical histological pattern of pure AFOP. Molecular analyses of lung tissue were positive for influenza A/H1N1.ConclusionTo our knowledge we present the first case of AFOP triggered by viral infection, here proven to be influenza virus A/H1N1. Thus, also in the setting of viral infection the highly deadly differential diagnosis of AFOP must be considered.

Rare idiopathic interstitial pneumonias: LIP and PPFE and rare histologic patterns of interstitial pneumonias: AFOP and BPIP

“…However, in some cases, focal or diffuse organizing pneumonia predominates, in keeping with the outcome dichotomy described above. Traction bronchiectasis and fibrosis can also develop . AFOP manifesting as a solitary mass has been reported .…”

Pulmonary Manifestations of Acute Lung Injury: More Than Just Diffuse Alveolar Damage

“…AFOP has also been reported following hematopoietic stem cell transplantation and lung transplantation. 6,35,[38][39][40][41] A definitive diagnosis of AFOP should be made only on large biopsy specimens because organizing alveolar fibrin may be seen as a nonspecific reaction adjacent to other processes, such as abscesses, granulomas, or neoplasms, and to ensure the absence of otherwise diagnostic features of entities within the differential diagnosis of DAD, OP, and EP. 6,37,42 DAD may prominently feature organizing fibrin, but there should always be typical hyaline membranes, however focal, present.…”

Successful Lung Retransplantation in a Patient With Acute Fibrinous and Organizing Pneumonia: A Case Report

“…Otto et al [6] reported a case of AFOP with concomitant influenza A/H1N1 pneumonia following lung transplantation. The patient suffered from end-stage pulmonary fibrosis and had received a double-lung transplantation.…”

“…Although the majority of cases are idiopathic, AFOP has been associated with a number of different conditions, including systemic diseases (eg, systemic lupus erythematosus) [2], collagen vascular disorders [3], hematopoietic stem cell transplantation [4], infections of bacterial [5] or viral [6] origin, acute respiratory distress syndrome [7], exposure to certain drugs (eg, amiodarone, statins, abacavir) [7], and following lung transplantation [6,8]. To date, there is no clear consensus on the main predisposing factors.…”