Two methods of lung biopsy for histological confirmation of acute fibrinous and organizing pneumonia: A case report

Abstract

BACKGROUND Acute fibrinous and organizing pneumonia (AFOP) is a rare, noninfective lung disease, histologically characterized by a patchy distribution of intra-alveolar fibrin “balls” and organizing pneumonia. The clinical manifestations of AFOP are nonspecific. Diagnosis depends on pathology. Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP. However, many patients have no tolerance to the operation, including mentally and physically. There is still no standard therapy for AFOP and the methods remain controversial. Therefore, further clinical attention and discussion are warranted. CASE SUMMARY A 53-year-old woman presented with fever, cough and dyspnea for 15 d. Anti-infective therapy was ineffective. Chest computed tomography showed bilateral patchy consolidation, especially in the lower lobes. We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations. Both samples supported the diagnosis of AFOP. The patient had a good clinical course after treatment with methylprednisolone, and no side effects of steroids. CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy. Methylprednisolone alone is effective in the treatment of idiopathic AFOP.