Bronchiolitis Obliterans Organizing Pneumonia Associated with AcuteMycoplasma pneumoniaeInfection

Abstract

A patient with bronchiolitis obliterans organizing pneumonia (BOOP) associated with acute Mycoplasma pneumoniae infection is described. Although mycoplasmas have occasionally been associated with bronchiolitis obliterans, to the best of our knowledge, this is the first well-documented case of BOOP associated with M. pneumoniae infection. The diagnosis of BOOP was made by open-lung biopsy after fiberoptic transbronchial biopsy proved nondiagnostic. Corticosteroid therapy was administered and a dramatic improvement was observed; the patient remained without complaints during a 3-year follow-up period.Bronchiolitis obliterans organizing pneumonia (BOOP) is a L (68% and 65%, respectively, of expected values). A highresolution CT scan showed bilateral airspace consolidations in potentially reversible histopathologic condition seen in the lung either as an idiopathic clinical syndrome or as a nonspecific the upper and middle right lobes and in the upper left lobe in association with hilar lymphadenopathies (1 cm in diameter). reaction to injury in a variety of situations, including infections [1]. Mycoplasmas have a wide range of immunomodulatory A 2-week course of therapy with erythromycin and cefonicid was administered. Serological assays revealed no diagnostic effects and have previously been associated with bronchiolitis obliterans (BO) without organizing pneumonia [2 -4]. A causal rise in titers of antibody to Epstein-Barr virus, cytomegalovirus, Legionella pneumophila (serogroups 1 -6), Coxiella burnetii, relationship has also been suggested in experimental studies [5]. However, the component of organizing pneumonia was or Chlamydia. Antibodies to M. pneumoniae were clearly documented by an IgG ELISA: first titer (at admission), 1.05; second lacking in all these reports. To our knowledge, we report the first well-documented case of BOOP associated with Mycotiter (4 weeks later), 2.95; ratio of second-to-first titers, 2.81 (seroconversion is defined by a ratio ú1.64) [6]. plasma pneumoniae infection.Fever (temperature, 37.3ЊC), exertional dyspnea, dry cough, and a high erythrocyte sedimentation rate (80 -92 mm/h) perCase Report sisted. A chest roentgenogram obtained 1 month later revealed the persistence of bilateral, mainly peripheral, migratory patchy A 57-year-old woman was admitted to the hospital because infiltrates in areas that were affected during the first admission of a 10-day history of cough, low-grade fever, and exertional (figure 2). The control WBC count was 7,900/mm 3 , with 948 dyspnea. Physical examination revealed tachypnea, fever (temeosinophils/mm 3 . The patient was admitted again, and fiberopperature, 37.7ЊC), and diffuse crackles in both lungs. Laboratic bronchoscopy was performed. Samples obtained with a teletory studies disclosed the following values: PO 2 , 61 mm Hg; scoping plugged catheter were cultured, but no aerobic bacteria PCO 2 , 36 mm Hg (measured while the patient was breathing or Legionella were isolated. Cytological examination of the room air); hemoglobin, 13.5 g/dL; WBC co...

Significant Role of Interleukin-8 in Pathogenesis of Pulmonary Disease Due to Mycoplasma pneumoniae Infection

“…An increasing number of reports on clinical observations have disclosed the beneficial effects of corticosteroids on the treatment of severe lower respiratory tract diseases due to Mycoplasma pneumoniae infection (1,2,9). This strengthens the concept of immunological mechanisms underlying these disease manifestations associated with M. pneumoniae infection.…”

“…It has been widely recognized that the pathologic feature of M. pneumoniae pneumonia is characterized by the mononuclear cell or lymphoplasmacytic cell infiltration at the site of inflammation (1,2,7,9). In this respect, Rollins et al (10) reported that while the bronchiolar infiltrates were mainly plasma cells and lymphocytes, it was polymorphonuclear leucocytes that were predominantly found in bronchiolar luminal contents and intra-alveolar contents.…”

Reactive Species Mediate Inhibition of Alveolar Type II Sodium Transport during Mycoplasma Infection

“…Significant pulmonary complications may occur, including pleural effusion, pneumatocele, lung abscess, pneumothorax, bronchiectasis, chronic interstitial fibrosis, and respiratory distress syndrome (reviewed in Reference 27). Likewise, bronchiolitis obliterans with fibrin deposits within intraalveolar lesions and respiratory insufficiency have been reported as a commonly unrecognized complication of M. pneumoniae infection (27,(30)(31)(32).…”

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

“…Edema of bronchial and bronchiolar walls; bronchiolar and alveolar infiltrates of macrophages, lymphocytes, neutrophils, plasma cells, and fibrin; and bronchiolitis obliterans have been described (65,77,93,259,277,352,372,432). Type II pneumocyte hyperplasia and diffuse alveolar damage have also been reported.…”