Tuberc Respir Dis.  2006 Nov;61(5):479-483. 10.4046/trd.2006.61.5.479.

A Case of Acute Fibrinous and Organizing Pneumonia

• Cho JY
• Lee HK
• Lee SS
• Lee HK
• Lee YM
• Lee HP
• Kim JI
• Choi SJ
• Yum HK

• KMID: 1970254
• DOI: http://doi.org/10.4046/trd.2006.61.5.479

Abstract

Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern consisting of prominent intra-alveolar fibrin and organizing pneumonia, with out hyaline membranes or prominent eosinophilia. The clinical manifestations of AFOP resemble those of acute lung injury such as acute interstitial pneumonia (AIP). However, the classic histological patterns of AFOP differ from diffuse alveolar damage (DAD), bronchiolitis obliterans with organizing pneumonia (BOOP) or acute eosinophilic pneumonia (AEP). The characteristic intra-alveolar fibrin ball and lack of classic hyaline membrane are the predominant histological features of AFOP. Although some reports suggest that its clinical course is less catastrophic than DAD, the clinical entity that distinguishes AFOP from DAD has not been established. We present a case of pathologically demonstrated AFOP in a 79-year-old man. The radiological findings of our case were similar to those of DAD, presented with diffuse bilateral lung infiltrations. However, despite the rapid development of respiratory failure, the patient had a better response and outcome to steroid therapy than what would be expected for DAD.

Keyword

Acute fibrinous and organizing pneumonia; DAD; AIP; AFOP

MeSH Terms

Acute Lung Injury
Aged
Bronchiolitis Obliterans
Eosinophilia
Fibrin*
Humans
Hyalin
Lung
Lung Diseases, Interstitial
Membranes
Pneumonia*
Pulmonary Eosinophilia
Respiratory Insufficiency
Fibrin

Figure

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  Figure 1 Chest PA. (A) Prominent bilateral asymmetric patchy infiltrations through both middle and lower lung fields were seen on admission. (B) After high-dose methylprednisolone therapy for 7 days, the parenchymal infiltrates through both lung fields are improved (extubation state).

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  Figure 2 Computed tomography of chest. Diffuse, extensive ground glass appearance and fine reticular patterns were noted on both upper and lower lung fields.

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  Figure 3 (A) Thoracoscopic lung biopsy of right middle and lower lobes. Exuberant intra-alveolar fibrin and organizing loose connective tissue involved more than 50% of air spaces with patchy distribution (H&E, ×40). (B) Thoracoscopic lung biopsy of right middle and lower lobes. Exuberant intra-alveolar fibrin and organizing loose connective tissue involved more than 50% of air spaces with patchy distribution (H&E, ×40).

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