Severe Acute Fibrinous and Organizing Pneumonia with Acute Respiratory Distress Syndrome

Abstract

Acute fibrinous and organizing pneumonia is a newly recognized pattern of acute lung injury. A 49-year-old female presented with a cough and worsening dyspnea on exertion. She had no history of smoking and no specific past medical history except exposure of home humidifier containing sterilizer. A chest computed tomography scan showed patchy consolidation with fibrosis in the right lower lobe and ill-defined centrilobular ground glass opacity in both lungs. The pathological findings were patchy areas of lung parenchyma with fibrin deposits in the alveolar ducts and alveoli, and fibrin balls with hemosiderin deposition in the alveolar spaces. The histological pattern of our case is differentiated from diffuse alveolar damage by the absence of hyaline membranes, and from eosinophilic pneumonia by the lack of eosinophils. In our case, the patient was treated with corticosteroid pulse therapy. However, the clinical course became aggravated and she died within two weeks.

Acute Fibrinous and Organizing Pneumonia with Myelodysplastic Syndrome: Corticosteroid Monotherapy Led to Successful Ventilator Weaning

“…In our case, we initiated corticosteroid treatment from day 8 after the onset of the respiratory symptoms, which corresponded to day 1 of intubation. In the six fatal cases corticosteroid therapy was not initiated until 10 or more days after the onset of symptoms ( 4 - 6 , 8 ). Patients who began to receive corticosteroids within 10 days of the onset of respiratory symptoms tended to have a better survival rate than those who did not (67% vs. 14%, p=0.18; Fisher's exact test.…”

“…Acute fibrinous and organizing pneumonia (AFOP) follows a clinical course of acute or subacute lung injury and has a distinct histological pattern. The prognosis of patients with severe AFOP who require intubation and mechanical ventilation is reported to be poor ( 1 , 4 - 8 ), with only a few successfully treated cases on record ( 2 , 3 ). We herein discuss the case of a patient with severe AFOP who required ventilatory support and who was successfully extubated after corticosteroid monotherapy.…”

Clinical features and long-term prognosis of acute fibrinous and organizing pneumonia histologically confirmed by surgical lung biopsy

“…Three patients had a history of bone marrow transplantation and one patient had a history of kidney transplantation in our study. Two patients finally proved to have an association with a specific humidifier disinfectant, which was known to have caused toxic lung injury in South Korea between 1995 and 2011 [ 11 , 12 ]. However, survival was not different according to the presence of associated causes or immunocompromised status.…”