Infect Chemother.  2010 Apr;42(2):112-116.

A Case of Bronchiolitis Obliterans Organizing Pneumonia Associated with Pandemic Influenza (H1N1 2009)

• Lim MH
• Heo ST
• Kim HC
• Bae IG
• Kim JH
• Kim IS
• Kim S
• Ko GH

Abstract

Several types of influenza-related pneumonia have been reported. Bronchiolitis obliterans organizing pneumonia (BOOP) is a nonspecific lung injury. A 64-year-old man sought care to an emergency room due to breathing difficulties. He was diagnosed with pandemic influenza (H1N1 2009) by the real-time polymerase chain reaction (PCR) and was suspected of concomitant bacterial pneumonia. Therefore he was treated with oseltamivir and broad spectrum antibiotics. The disease progressed rapidly despite treatment, so a corticosteroid was added. The trans-bronchial lung biopsy was consistent with BOOP. Here, we investigated BOOP associated with the pandemic influenza (H1N1 2009) virus that was successfully treated with a combination of antiviral, antibacterial and corticosteroid drugs. Although BOOP associated with influenza is rare, combined disease should be suspected especially when the pneumonia does not response to antiviral agents and antibiotics.

Keyword

Pandemic influenza; Bronchiolitis obliterans organizing pneumonia; Oseltamivir; Corticosteroid

MeSH Terms

Anti-Bacterial Agents
Antiviral Agents
Biopsy
Bronchiolitis
Bronchiolitis Obliterans
Cryptogenic Organizing Pneumonia
Emergencies
Humans
Influenza, Human
Lung
Lung Injury
Middle Aged
Oseltamivir
Pandemics
Pneumonia
Pneumonia, Bacterial
Real-Time Polymerase Chain Reaction
Respiration
Viruses
Anti-Bacterial Agents
Antiviral Agents
Oseltamivir

Figure

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  Figure 1 Chest radiograph of patient at admission (A) Simple chest radiography shows patchy consolidation in the right lung. (B) High-resolution computed tomography reveals consolidations and ground glass opacities in the right whole lung field.

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  Figure 2 Chest radiograph of patient at readmission (A) Simple chest radiography shows consolidation in the left lung. (B) High-resolution computed tomography reveals consolidations and ground glass opacities in left upper and lower lobes.

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  Figure 3 A lung biopsy specimen shows fibroblastic plugs (arrows), the hallmark of the bronchiolitis obliterans organizing pneumonia. The fibroblastic plugs consist of spindle-shaped fibroblasts embedded in a loose matrix, and obstruct terminal bronchioles. A proximal portion of the bronchiole is seen on the right side (open arrows), and a relatively normal portion of the lung on the left side (H&E stain, ×100).

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