Tuberc Respir Dis.  2007 Jun;62(6):540-544.

A Case of Secondary Organizing Pneumonia Occurring in Therapy for Lung Abscess

• Yoon HY
• Oh SU
• Park JG
• Sin TR
• Park SM

Abstract

The patient is a 62-year-old man with known diabetes mellitus who presented with a two-weeks-history of dyspnea, cough, and fever. He was diagnosed with a lung abscess in the right upper lobe and was treated with intravenous antibiotics. The patient's clinical and radiological findings improved within seven days after medical treatment. However, newly developed ground-glass opacity and infiltrations were observed in the right lower lung. Fourteen days after admission, the patient's symptoms and imaging finding became aggravated despite trestment with susceptible antibiotics for lung abscess. Trans-bronchial lung biopsy (TBLB) was performed in the lateral basal segment of the right lower lobe of the lung. A histologic photomicrograph showed organizing pneumonia, also called bronchiolitis obliterans with organizing pneumonia(BOOP), that became more definite as the terminal bronchioles and alveoli became occluded with masses of inflammatory cells and fibrotic tissue. The clinical symptoms and radiograph findings resolved quickly with prednisone treatment. We report a case of secondary organizing pneumonia diagnosed after TBLB following lung abscess treatment and provide a review of the literature.

Keyword

Lung abscess; Organizing pneumonia; TBLB

MeSH Terms

Anti-Bacterial Agents
Biopsy
Bronchioles
Bronchiolitis Obliterans
Cough
Diabetes Mellitus
Dyspnea
Fever
Humans
Lung Abscess*
Lung*
Middle Aged
Pneumonia*
Prednisone
Anti-Bacterial Agents
Prednisone

Figure

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  Figure 1 Chest radiograph and computed tomography showing a loculated lung absecss in the right upper lobe.

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  Figure 2 Chest radiograph and CT scan showing air-fluid level characteristic of lung abscess and septated lesion in the right upper lobe. Clinical and imaging improvement was obtained with intravenous antibiotics treatment.

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  Figure 3 Chest radiograph showing newly developed and aggravated patchy opacities in right lower lobe.

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  Figure 4 After corticosteroid treatment, the patchy opacities on chest radiograph was improved.

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  Figure 5 Photomicrograph of specimen from TBLB in a patient with cryptogenic organizing pneumonia. Polypoid masses of granulation tissue fill the lumens of a respiratory bronchiole and alveolar ducts(A). Alveolar wall(B) (H&E stain, ×100).

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