Acute fibrinous and organizing pneumonia

Abstract

IntroductionAcute fibrinous and organizing pneumonia (AFOP) is a rare diffuse pulmonary disease, but it is not yet known whether it is a distinct form of interstitial pneumonia or simply a reflection of a tissue sampling issue.MethodsCross-sectional evaluation of clinical and radiological findings, treatments, and outcomes for patients with histologically confirmed AFOP at a tertiary university hospital between 2002 and 2015.ResultsThirteen patients (7 women, 53.8%) with a mean ± SD age of 53.5 ± 16.1 years were included. The main symptoms were fever (69.2%), cough (46.2%), and chest pain (30.8%). All patients presented a radiological pattern of consolidation and 5 (38.5%) had simultaneous ground-glass areas. Histology was obtained by computed tomography-guided transthoracic biopsy in 61.5% of cases and by surgical lung biopsy in the remaining cases. Several potential etiologic factors were identified. Eight patients (61.5%) had hematologic disorders and 3 had undergone an autologous hematopoietic cell transplant. Two (15.4%) had microbiologic isolates, 5 (38.4%) had drug-induced lung toxicity, and 2 (15.4%) were classified as having idiopathic AFOP. In addition to antibiotics and diuretics used to treat the underlying disease, the main treatment was corticosteroids, combined in some cases with immunosuppressants. Median survival was 78 months and 6 patients (46.2%) were still alive at the time of analysis.ConclusionOur findings for this series of patients confirm that AFOP is a nonspecific reaction to various agents with a heterogeneous clinical presentation and clinical course that seems to be influenced mainly by the severity of the underlying disorder.

Acute Fibrinous and Organizing Pneumonia: A Case Report and Review of the Literature

“…These nonspecific symptoms result in a delay in the diagnosis of AFOP. Beasley and collaborators described a mean time from onset of symptoms to diagnosis of 19 days, and Gomes and coworkers reported a mean time of 43.9 days [ 1 , 5 ].…”

“…Acute fibrinous organizing pneumonia (AFOP) is a rare condition of the lung that is associated with acute lung injury, has a poor prognosis, and is characterized histologically by intra-alveolar fibrin. [ 1 ]. A wide variety of signs, symptoms, and radiographic findings make AFOP difficult to diagnose clinically, and a lung biopsy is required for the diagnosis [ 2 ].…”

An Unusual Presentation of Acute Fibrinous and Organizing Pneumonia

“…Gomes et al reported 8 cases of AFOP associated with hematologic disorders, 5 cases associated with drug-induced lung toxicity, 2 cases associated with infections, and 2 idiopathic cases [7]. Two clinical scenarios were described: the first is fulminant, often overlapping with ARDS; and the second is more sub-acute [1], with a favorable treatment response and disease progression.…”

A case of herbicide-induced acute fibrinous and organizing pneumonia?

“…However, AFOP has not been included in the clinical category of idiopathic interstitial pneumonia (IIP) but has been referred to as a rare pathological type in recent years [ 2 ]. Interestingly, AFOP symptoms are not typical; patients commonly present with dyspnoea, cough, fever, etc., which makes it more difficult to diagnose compared to other diseases [ 1 , 3 , 4 ]. In addition, the treatment of AFOP is controversial; both glucocorticoids and immunosuppressive agents have been shown to be effective [ 1 , 3 , 4 ].…”

“…Interestingly, AFOP symptoms are not typical; patients commonly present with dyspnoea, cough, fever, etc., which makes it more difficult to diagnose compared to other diseases [ 1 , 3 , 4 ]. In addition, the treatment of AFOP is controversial; both glucocorticoids and immunosuppressive agents have been shown to be effective [ 1 , 3 , 4 ]. To improve the understanding of AFOP, we herein present one case of a patient with AFOP proven by pathology, whose clinical symptoms were significantly relieved by glucocorticoid treatment.…”