Treatment of acute fibrinous organizing pneumonia following hematopoietic cell transplantation with etanercept

Simmons, Gary; Chung, Hsiao Min; McCarty, JM; Toor, Amir A.; Farkas, Daniela; Miller, Kelly A.; Clark, William

doi:10.1038/bmt.2016.197

Cited by 15 publications

(13 citation statements)

References 12 publications

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“…When all measures and diagnostic procedures fail to provide a definitive diagnosis with a fatal outcome, post mortem lung tissue study provides an important tool for the understanding of the underlying pathologic process in order to improve, in future cases, diagnosis and treatment [17,18].…”

Section: Discussionmentioning

confidence: 99%

Pathophysiology of acute fibrinous and organizing pneumonia – Clinical and morphological spectra

et al. 2019

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a b s t r a c tAcute Fibrinous and Organizing Pneumonitis (AFOP) is a disease with histopathological pattern characterized by the presence of intra-alveolar fibrin in the form of fibrin "balls" and organizing pneumonia represented by inflammatory myofibroblastic polyps. Symptoms of this rare interstitial pulmonary disease can be either acute or sub-acute and it can rapidly progress to death. Diagnosis should be considered in the Intensive Care Unit (ICU) if patients' symptomatology and radiology correlates with non-responding or progressive pneumonia and when morphology, on biopsies, encompasses criteria of diffuse alveolar damage (DAD) and organizing pneumonia (OP) balancing in between.Three clinical cases of patients presenting severe lung disease requiring mechanical ventilation and prolonged intensive care fitted on the variable spectra of AFOP histopathology and had poor outcome: a 23 year-old women had AFOP in the context of antiphospholipid syndrome pulmonary compromise; a 35 year-old man developed a letal intensive care pneumonia with AFOP pattern registered in post-mortem biopsy; and a 79 year-old man died 21 days after intensive care unit treatment of a sub-pleural organizing pneumonia with intra-alveolar fibrin, seen in post-mortem biopsy.The predominance of acute fibrin alveolar deposition pattern is helpful in raising AFOP differential diagnosis while organizing pneumonia pattern establishes a wider range of diagnosis that can go till solitary pulmonary nodule, remaining indefinite to suggest diagnosis. The performance time of biopsy in a larger number of clinical cases may be helpful in establishing the evolutionary morphological pattern, taking in mind the poor outcome of the disease, deserving rapid diagnosis to define treatment.

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Section: Discussionmentioning

confidence: 99%

Pathophysiology of acute fibrinous and organizing pneumonia – Clinical and morphological spectra

et al. 2019

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“…A known inducer of HO-1 is TNF-α [ 12 ]. Etanercept, a TNF inhibitor, has been reported as an effective treatment for acute lung injury and in a case of AFOP [ 11 , 13 ]. A TNF inhibitor was not initially used in our patient as the patient showed an initial response to steroids and cyclophosphamide.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Patient: Female, 35Final Diagnosis: Acute fibrinous and organizing pneumoniaSymptoms: Shortness of breathMedication: —Clinical Procedure: Video assisted thoracoscopic lung biopsySpecialty: PulmonologyObjective:Unknown ethiologyBackground:Acute fibrinous organizing pneumonia (AFOP) is a rare condition of the lung that is associated with acute lung injury, and has a poor prognosis. AFOP is characterized histologically by intra-alveolar fibrin. AFOP has been described to be associated with lung infections, connective tissue disorders, drugs, toxic environmental exposure, and in lung transplantation. However, most cases of AFOP remain idiopathic, and because the condition can present with a wide variety of clinical manifestations, open lung biopsy or video-assisted thoracoscopic (VAT) lung biopsy is necessary for the diagnosis. Currently, treatments for AFOP remain under investigation.Case Report:A 35-year-old woman presented with a cough and dyspnea, and was initially diagnosed to have pneumonia. Due to the progression of her symptoms and increasing respiratory failure she underwent video-assisted thoracoscopic (VAT) biopsy and was diagnosed with AFOP, 19 days following hospital admission. She was treated with mechanical ventilation, intravenous steroids, and cyclophosphamide. She required tracheostomy after 14 days of mechanical ventilation and died two weeks later.Conclusions:AFOP is an uncommon clinical condition, with a poor prognosis, which often has a delay in diagnosis. Some patients benefit from steroids and immunosuppressive therapy. Currently, new treatments for AFOP are under investigation.

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“…In the past few years, several cases of acute fibrinous and organizing pneumonia (AFOP) have been described in the early and late post-HSCT period. [95][96][97] AFOP is a rare, distinct type of acute lung injury that requires pathologic evaluation for diagnosis. The presence of diffuse alveolar damage and organizing pneumonia with extensive, diffuse intra-alveolar fibrin deposition without hyaline membranes is characteristic.…”

Section: Acute Fibrinous and Organizing Pneumoniamentioning

confidence: 99%

“…In the non-HSCT setting, AFOP has been associated with autoimmune disorders, malignancy, infection, and drug toxicity. 97 Patients have been reported to present with cough, fevers, and dyspnea. AFOP may have a subacute or more aggressive course with rapid progression to respiratory failure.…”

Section: Acute Fibrinous and Organizing Pneumoniamentioning

confidence: 99%

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Noninfectious Acute Lung Injury Syndromes Early After Hematopoietic Stem Cell Transplantation

Ahya

2017

Clinics in Chest Medicine

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Noninfectious acute lung injury syndromes are major causes of respiratory failure and early mortality after hematopoietic stem cell transplantation (HSCT). Pulmonary edema and transfusion-related acute lung injuries are important respiratory complications seen after HSCT and in the nontransplant setting. Early transplant-specific causes of lung injury, such as idiopathic pneumonia syndrome, are reviewed. Several complications, such as drug-induced pneumonitis and cryptogenic organizing pneumonia, that occur in both the early and later time periods after HSCT are also briefly discussed. The important role of pretransplant pulmonary function testing measurements in predicting posttransplant respiratory failure is highlighted.

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Treatment of acute fibrinous organizing pneumonia following hematopoietic cell transplantation with etanercept

Cited by 15 publications

References 12 publications

Pathophysiology of acute fibrinous and organizing pneumonia – Clinical and morphological spectra

Pathophysiology of acute fibrinous and organizing pneumonia – Clinical and morphological spectra

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

Noninfectious Acute Lung Injury Syndromes Early After Hematopoietic Stem Cell Transplantation

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