Bronchiolitis Obliterans Organizing Pneumonia

Abstract

In 50 of 94 patients with bronchiolitis obliterans we found no apparent cause or associated disease, and the bronchiolitis obliterans occurred with patchy organizing pneumonia. Histologic characteristics included polypoid masses of granulation tissue in lumens of small airways, alveolar ducts, and some alveoli. The fibrosis was uniform in age, suggesting that all repair had begun at the same time. The distribution was patchy, with preservation of background architecture. Clinically, there was cough or flu-like illness for 4 to 10 weeks, and crackles were heard in the lungs of 68 per cent of the patients. Radiographs showed an unusual pattern of patchy densities with a "ground glass" appearance in 81 per cent. Physiologically, there was restriction in 72 per cent of the patients, and 86 per cent had impaired diffusing capacity. Obstruction was limited to smokers. The mean follow-up period was four years. With corticosteroids, there was complete clinical and physiologic recovery in 65 per cent of the subjects; two died from progressive disease. This disorder differs from bronchiolitis obliterans with irreversible obstruction. It was confused most often with idiopathic pulmonary fibrosis. In view of the benign course and therapeutic response, a histologic distinction is important.

Bronchiolitis obliterans organizing pneumonia and ulcerative colitis after allogeneic bone marrow transplantation

“…Although its physiopathology remains unclear, BOOP has been observed in the context of various autoimmune disorders and in particular inflammatory bowel diseases. 5 The pathogenesis of ulcerative colitis remains unclear but autoimmunity has been highlighted among genetic, allergic, dietary, infectious and immunologic mechanisms, and immunosuppressive agents such as prednisolone or cyclosporine can improve it. In the context of BMT, these two infrequent diseases may also have a toxic, infectious or GVHD-related etiology.…”

“…5 In all cases of BMT-related BOOP, the preparative regimen included cyclophosphamide and in seven of eight cases total body irradiation (TBI) ( Table 1). However, the delay between conditioning and the onset of symptoms renders this explanation unlikely in our patient.…”

“…[2][3][4] BOOP has also been described in several patients with inflammatory bowel disease. 5 We report a new case of BMT-associated BOOP which developed in the recipient of a marrow transplant from a donor who suffered from Crohn's disease. As the patient simultaneously developed ulcerative colitis and BOOP about 6 months after BMT, this observation could Correspondence: Dr Y Beguin, University of Liège, Department of Hematology, CHU Sart-Tilman, 4000 Liège, Belgium Received 15 August 1997; accepted 11 November 1997 constitute a case of adoptive autoimmunity in which transmission from donor to recipient of inflammatory bowel disease could have contributed to the pathogenesis of BMTassociated BOOP.…”

Bronchiolitis Obliterans with Organising Pneumonia presenting as Non Resolving Pneumonia

“…It was in 1985, when a subclass of such patients with lung fibrosis was recognised to be having different clinical, radiological, histopathological and prognostic features as compared to other pulmonary fibrotic disorders like obliterative bronchiolitis (OB) and idiopathic pulmonary fibrosis (IPF). The subset of patients with this disease was characterised by granulation tissue plugs within the lumens of bronchioles and extension of this fibroinflammatory process into alveolar ducts and alveoli mimicking organising pneumonia and having different therapeutic and prognostic implications [5]. Aetiologically it is either a primary BOOP or secondary to various pulmonary insults like toxic fumes in welding trade as in our case, post infectious BOOP due to chlamydia, legionella, mycoplasma, adenoviruses, cytomegalo virus and influenza virus, drugs related BOOP, secondary to collagen vascular diseases and post transplant BOOP [6].…”

“…The subset of patients with this disease was characterised by granulation tissue plugs within the lumens of bronchioles and extension of this fibroinflammatory process into alveolar ducts and alveoli mimicking organising pneumonia and having different therapeutic and prognostic implications [5]. Aetiologically it is either a primary BOOP or secondary to various pulmonary insults like toxic fumes in welding trade as in our case, post infectious BOOP due to chlamydia, legionella, mycoplasma, adenoviruses, cytomegalo virus and influenza virus, drugs related BOOP, secondary to collagen vascular diseases and post transplant BOOP [6]. Various chest radiographic findings have been described in BOOP but the typical chest radiograph shows bilateral peripheral patchy acino nodular infiltrates, migratory in nature in 10 to 25% cases [7].…”