A case report of fungal infection associated acute fibrinous and organizing pneumonitis

Abstract

Background: Acute fibrinous and organizing pneumonitis (AFOP) is an uncommon variant of acute lung injury, characterized by intra-alveolar fibrin and organizing pneumonia. Proposed etiologies include connective tissue diseases, infections, occupational exposure, drug reactions, and autoimmune disease. Here we present a rare case of fungal infection associated AFOP in patient with diabetes mellitus (DM) and review the relevant literature. Case presentation: A 67-year-old man complained of cough, fever, dyspnea and hemoptysis. Patient experienced a rapidly progressive course exhibit diffuse predominant consolidation, ground glass opacities, and multifocal parenchymal abnormalities on chest computed tomography (CT). Antibacterial, antifungal, and antiviral treatments were ineffective. A CT-guided percutaneous lung biopsy was performed. Histologically, the predominant findings were as follows: alveolar spaces filled with fibrin and organizing loose connective tissues involving 70% of the observed region, pulmonary interstitial fibrosis, and small abscesses and epithelioid cell granuloma in the focal area. Result of periodic acid-silver methenamine stain was positive. The fungal pathogen from the sputum culture was identified as P. citrinum repeatedly over 3 times. Patient was diagnosed with DM during hospitalization. Corticosteroids combined with an antifungal therapy were effective. Follow-up for 4 months showed complete radiological resolution. Conclusions: As this common "contaminant" can behave as a pathogen in the immunocompromised host, both clinicians and microbiologists should consider the presence of a serious and potentially fatal fungal infection on isolation of P. citrinum. Based on this case, it could be speculated that AFOP may be associated with fungal infection including P. citrinum.

Acute fibrinous and organizing pneumonia in a patient with Sjögren’s syndrome and Legionella pneumonia: a case report and literature review

“…The clinical manifestations of AFOP lack specificity and primarily manifest as shortness of breath, cough, and fever. AFOP may be related to numerous clinical conditions, such as infections, autoimmune diseases, adverse drug reactions, and environmental exposures (Table 2 ) [ 1 , 3 – 9 , 11 – 13 ]. There are no significant differences in the clinical and lung imaging manifestations of AFOP according to the cause.…”

“…AFOP may improve following antibiotic treatment [ 14 ], suggesting that infection may trigger the onset of AFOP. Previous reports have shown that a variety of infections may be associated with AFOP, including bacterial infections ( Haemophilus influenzae , Acinetobacter baumannii ), viral infections (respiratory syncytial virus, influenza virus A/H1N1, human immunodeficiency virus), and fungal infections ( Pneumocystis jirovecii , Penicillium citrinum ) [ 1 , 5 – 9 ]. In the reported case, Legionella pneumonia was diagnosed based on a history of contact with soil before the onset; symptoms of fever, expectoration and shortness of breath; extrapulmonary manifestations (gastrointestinal symptom, liver function injury and hyponatremia), and the positive Legionella urine antigen test result.…”

“…The onset may be related to infection, autoimmune disease, adverse drug reactions, and environmental exposures [ 3 ]. Pathogens reported to be associated with AFOP include Haemophilus influenzae , Acinetobacter baumannii , Chlamydia , respiratory syncytial virus, influenza virus A/H1N1, human immunodeficiency virus, and Pneumocystis jirovecii , Penicillium citrinum et al [ 1 , 4 – 9 ]. To our knowledge, there have been no reports of AFOP associated with Legionella infection.…”