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Cho, Lee, Lee, Lee, Lee, Lee, Kim, Choi, and Yum: A Case of Acute Fibrinous and Organizing Pneumonia
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 61(5): 479-483.

Published online: 30 November 2006

DOI: https://doi.org/10.4046/trd.2006.61.5.479

A Case of Acute Fibrinous and Organizing Pneumonia

Joo Yeon Cho, M.D., Hyun Kyung Lee, M.D., Sung Soon Lee, M.D., Hye Kyung Lee, M.D.1, Young Min Lee, M.D., Hyuk Pyo Lee, M.D., Joo In Kim, M.D., Soo Jeon Choi, M.D., Ho-Kee Yum, M.D.

Department of Internal Medicine, Inje University, Sooul, Korea.

1Department of Pathology, Inje University, Sooul, Korea.

Address for correspondence: Ho-Kee Yum, M.D. Department of Internal Medicine, Seoul Paik Hospital, Inje University, 85, 2-Ga, Jeo-Dong, Jung-Gu, Seoul, Korea 100-032. Phone: 82-2-2270-0004, Fax: 82-2-2285-2286, pulho@korea.com

Received 8 June 2006       Accepted 13 September 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

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.

Keywords: Acute fibrinous and organizing pneumonia, DAD, AIP, AFOP

Figures and Tables

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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