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

Min Hee Lim; Sang Taek Heo; Ho Cheol Kim; In-Gyu Bae; Jae hee Kim; In-Suk Kim; Sunjoo Kim; Gyung Hyuck Ko

doi:10.3947/ic.2010.42.2.112

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Lim, Heo, Kim, Bae, Kim, Kim, Kim, and Ko: A Case of Bronchiolitis Obliterans Organizing Pneumonia Associated with Pandemic Influenza (H1N1 2009)

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(2): 112-116.

Published online: 30 April 2010

DOI: https://doi.org/10.3947/ic.2010.42.2.112

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

Min Hee Lim¹, Sang Taek Heo^1,⁴, Ho Cheol Kim^1,⁴, In-Gyu Bae^1,⁴, Jae hee Kim¹, In-Suk Kim^2,⁴, Sunjoo Kim^2,⁴, Gyung Hyuck Ko, ^3,⁴

¹Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.

²Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.

³Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea.

⁴Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.

Corresponding author: Sang Taek Heo, M.D. Department of Internal Medicine, Gyeongsang National University School of Medicine, 90 Chilam-Dong, Jinju 660- 702, Korea. Tel: +82-55-750-8874, Fax: +82-55-758-9122, cadevar@paran.com

Received 10 April 2010 Accepted 19 April 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Pandemic influenza, Bronchiolitis obliterans organizing pneumonia, Oseltamivir, Corticosteroid

Figures and Tables

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.

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.

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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