Acute fibrinous and organizing pneumonia: A rare form of nonbacterial pneumonia

Saxena, Prashant; Kumar, Kuldeep; Mittal, Sarita; Goyal, Nidhi; Trikha, Sahil; Vashisth, Arti

doi:10.4103/0972-5229.180048

Cited by 11 publications

(9 citation statements)

References 16 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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“…AFOP is a newly recognized histopathological entity of acute lung injury and has been proposed as a possible autonomic interstitial lung disease, although it is not included in the ATS/ERS classification of idiopathic interstitial pneumonias [5]. The pathological hallmark of AFOP was massive cellulose exudate with organization in the alveolar spaces, rather than the fibrous tissue and fibroblast proliferation seen in organizing pneumonia; the numerous eosinophils, macrophage infiltration and eosinophil abscesses formed in eosinophilic pneumonia; or the hyaline membranes seen in diffuse alveolar damage [6][7][8]. It could be idiopathic or could also be associated with infection [9,10], connective tissue disease [11,12], environmental exposures to diverse agents [13], drugs reaction [14], etc ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

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

A¹,

Wang²,

Zhou³

2020

Preprint

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Background Acute fibrinous and organizing pneumonia is an unusual histopathological pattern of acute lung injury. To improve the understanding of acute fibrinous and organizing pneumonia, we herein present one case of a patient with acute fibrinous and organizing pneumonia proven by percutaneous lung biopsy along with clinical features, chest imaging and pathology. Case presentation A 70-year-old man was admitted to our department and was initially diagnosed to have community-acquired pneumonia. He had no specific symptoms and signs on presentation. Chest computed tomography scan showed a high-density shadow in the right basement of the lower lobe. The patient was preliminarily diagnosed with community-acquired pneumonia; however, antibacterial treatment was ineffective. To confirm the diagnosis, we performed twice percutaneous lung biopsy, and pathology was consistent with acute fibrinous and organizing pneumonia. After he was treated with glucocorticoids, the shadow seen on imaging dissipated during the follow-up period. Conclusion Acute fibrinous and organizing pneumonia is a rare histopathological diagnosis, which often has a delay in diagnosis. Clinicians need to consider the possibility of acute fibrinous and organizing pneumonia in the case of invalid antibacterial therapy. Further studies are needed to better classify acute fibrinous and organizing pneumonia, and characterise its clinical presentations, course and treatment.

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“…First reported in 2002 in a 17-patient case series by Beasley et al, AFOP was described histologically as a condition that should be distinguished from diffuse alveolar damage (DAD), bronchiolitis obliterans with organizing pneumonia (BOOP), and eosinophilic pneumonia (EP) in the setting of acute lung injury [ 3 – 5 ]. More than 100 cases of AFOP have been reported in the literature [ 4 ]. Men are affected by AFOP slightly more commonly than women [ 2 , 6 , 7 ].…”

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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Acute fibrinous and organizing pneumonia: A rare form of nonbacterial pneumonia

Cited by 11 publications

References 16 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

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

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