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Na, Kim, Kim, Nam, Lee, Kim, Kie, and Hong: A Case of Bronchiolitis Obliterans Organizing Pneumonia from Epstein-Barr Virus
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 62(1): 51-55.

Published online: 31 January 2007

DOI: https://doi.org/10.4046/trd.2007.62.1.51

A Case of Bronchiolitis Obliterans Organizing Pneumonia from Epstein-Barr Virus

Hyoung Jung Na, M.D., Sueng Up Kim, M.D.1, Do Hyun Kim, M.D., Dong Hyug Nam, M.D., Sun Min Lee, M.D., Chong Ju Kim, M.D., Jeong-Hae Kie, M.D.2, Yong Kug Hong, M.D.3

Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

2Department of Pathology, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

3Department of Radiology, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

Address for correspondence: Chong Ju Kim, M.D. Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital 1232, Paeksok-dong, Ilsan-donggu, Koyang-shi, Kyunggi-do, 410-719, Korea. Phone: 82-31-900-0237, Fax: 82-31-900-0343, kom2d@netsgo.com

Received 26 October 2006       Accepted 7 December 2006

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

In the average adult with a normal immune state, Epstein-Barr virus pneumonia is very rare, especially in the form of interstitial lung disease. According to recent studies, the Epstein-Barr virus is also associated with lymphocytic interstitial pneumonia, AIDS and Langerhans cell histiocytosis, but not with sarcoidosis. BOOP is caused by lung injury due to an infection or drug intoxication, and is related to connective tissue disease or bone marrow transplantation, but is sometimes idiopathic. We experienced a patient with symptoms and signs of interstitial lung disease, with confirmed BOOP and EBV ingection from an open lung biopsy and serologic examination, respectively Herein, this case is reported, with a review of the literature.

Keywords: Bronchiolitis obliterans organizing pneumonia, Epstein-barr virus

Figures and Tables

Figure 1
On H-E section, loose branching fibroblastic proliferations are observed within the terminal airway and alveolar spaces (A, H-E, ×200) with relatively mild interstitial inflammatory cell infiltration (B, H-E, ×400).
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Figure 2
Chest radiograph shows diffuse ground glass opacity and reticular opacity in the both lungs (A). Chest PA after 5 months shows resolution of diffuse ground glass and reticular opacity in the both lungs (B).
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Figure 3
Axial CT image shows diffuse patch distributed ground glass opacity and consolidation along the bronchovascular bundles (A). Three week follow-up Chest CT shows improvement of ground glass opacity and consolidation in the both lungs (B). Follow-up Chest CT after 1 year demonstrates resolution of diffuse pulmonary infiltration. Mild ground glass opacity and reticular opacity are remained (C).
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Table 1
Follow up findings of PFT values
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Table 2
Follow up findings of serum anti EBV immunoglobulin(U/mL)
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References

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2. Dodd JD, Muller NL. Bronchiolitis obliterans organizing pneumonia after bone marrow transplantation. J Comput Assist Tomogr. 2005. 29:540–543.
3. Ahn MS, Koh YM, Shin J, Jeong HB, Lee SE, Chung YT. A case of Pneumoncystis carinii pneumonia with histopathologic finding of bronchiolitis obliterans organizing pneumonia in patient with AIDS. Tuberc Respir Dis. 1998. 45:444–450.
4. Verma N, Soans B. Cryptogenic organizing pneumonia associated with Pneumocystis carinii infection and sirolimus therapy in a renal transplant patient. Australas Radiol. 2006. 50:68–70.
5. Chantraumat C, Sittipunt C. Bronchiolitis obliterans organizing pneumonia caused by capsule-deficient cryptococcosis. Southeast Asian J Trop Med Public Health. 2005. 36:174–177.
6. Epler GR. Bronchiolitis obliterans organizing pneumonia. Arch Intern Med. 2001. 161:158–164.
7. Marzouk K, Corate L, Saleh S, Sharma OP. Epstein-Barr-virus-induced interstitial lung disease. Curr Opin Pulm Med. 2005. 11:456–460.
8. Costabel U, Teschler H, Schoenfeld B, Hartung W, Nusch A, Guzman J, et al. BOOP in Europe. Chest. 1992. 102:Suppl. 14S–20S.
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