Life after acute fibrinous and organizing pneumonia: a case report of a patient 30 months after diagnosis and review of the literature

Our plain-English summary of Life after acute fibrinous and organizing pneumonia: a case report of a patient 30 months after diagnosis and review of the literature, by C. Kuza, T. Matheos, D. Kathman, et al (Journal of Critical Care, 2016).

The study

• Authors: C. Kuza, T. Matheos, D. Kathman, S.O. Heard
• Journal: Journal of Critical Care
• Published: 2016;31(1):255-61
• Type of article: Case report, Review
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Acute fibrinous and organizing pneumonia (AFOP) is a rare histologic interstitial pneumonia pattern recently described in the literature with fewer than 120 cases published. AFOP is often difficult to diagnose and may be mistaken for other pulmonary disorders such as interstitial pneumonias or pneumonitides. Patients often present with vague symptoms of cough, dyspnea, hemoptysis, fatigue, and occasionally respiratory failure. Radiological findings show diffuse patchy opacities and ground glass appearance of the lungs. On histologic examination, intra-alveolar fibrin balls are observed. We discuss a case of a man who presented with hemoptysis and dyspnea and whose open lung biopsy revealed AFOP. We will describe the presentation, diagnosis, and post-discharge course, and review the current literature. There are only 4 cases which have reported the patients' course of disease after 1 year, the longest being 2 years. To our knowledge, this is the only case of AFOP in the literature that describes the course of a patient more than 2 years after the diagnosis of AFOP, and is the most comprehensive review of the current literature.

Copyright © 2015 Elsevier Inc. All rights reserved.

In plain English

This article is a case report combined with a review of published cases of acute fibrinous and organizing pneumonia (AFOP), a rare pattern of lung inflammation. The patient was a 60-year-old male smoker with two months of worsening shortness of breath and blood-tinged sputum. He reported working with asbestos and fiberglass from 1975 to 1988 and recent occupational dust exposure. Bronchoscopic biopsies were negative for malignancy. A surgical lung biopsy showed AFOP with a background of chronic interstitial pneumonia. Eight months after discharge he was diagnosed with an unspecified connective tissue disease. The authors named asbestos and fiberglass exposure, as well as connective tissue disease, only as possible causes in this case. Several attempts to lower his steroid dose failed. Thirty months after discharge he still depended on immunosuppressive drugs and oxygen, was on disability, and had been listed for lung transplantation. In their review, the authors counted 111 published cases as of 2015, with follow-up reported for only 19 patients. The authors concluded that theirs was the longest reported follow-up and that few studies report long-term outcomes.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of one patient with a review of the published literature on AFOP
• Who was studied: One 60-year-old male smoker transferred to the authors' hospital (University of Massachusetts Medical School, Worcester, USA), followed for 30 months after discharge; the literature review covered 111 previously reported AFOP cases
• Exposure: Self-reported work with asbestos and fiberglass from 1975 to 1988, plus recent occupational dust exposure; no fiber type is specified
• Main results:
  • In the patient, bronchoscopic biopsies were negative for malignancy, granulomas and Pneumocystis jirovecii.
  • The patient's surgical lung biopsy showed AFOP with a background of chronic interstitial pneumonia.
  • Eight months after discharge, the patient developed arthralgias, Raynaud's syndrome and telangiectasias, and was diagnosed with an unspecified connective tissue disease.
  • The authors listed asbestos and fiberglass exposure, as well as connective tissue disease, as possible causes of this patient's AFOP.
  • Over 2 years, several attempts to taper the patient's steroids failed.
  • Thirty months after discharge, the patient remained dependent on mycophenolate mofetil, prednisone 10 mg daily and oxygen. He was on disability and had been listed for lung transplantation.
  • Literature review: 111 AFOP cases had been reported as of 2015.
  • Literature review: of the 51 deaths reported in the literature, 6 were unrelated to AFOP.
  • Literature review: follow-up was reported for only 19 patients and ranged from 2 weeks to 2 years.
• The authors' conclusion: The authors concluded that they present the longest follow-up of a patient diagnosed with AFOP, that few studies report long-term outcomes, and that definitive management is not yet clearly defined.
• Limitations the authors state:
  • The authors note that case reports are considered to be at the bottom of the hierarchy of reliable evidence for clinical decisions.
  • The authors note that time to death was not reported in most of the published cases they reviewed.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial, Dyspnea, Hemoptysis, Biopsy.

Related studies

• Desquamative interstitial pneumonia induced by metal exposure. A case report and literature review — T. Blin, A. De Muret, et al. (2020)
• Dyskeratosis congenita showing usual interstitial pneumonia — S. Imokawa, A. Sato, et al. (1994)
• Chronic inhalation study of fiber glass and amosite asbestos in hamsters: twelve-month preliminary results — T.W. Hesterberg, C. Axten, et al. (1997)
• Acute eosinophilic pneumonia in a New York City firefighter exposed to World Trade Center dust — W.N. Rom, M. Weiden, et al. (2002)
• Biphasic malignant mesothelioma with epithelioid and sarcomatoid components (dedifferentiated mesothelioma) and intrapulmonary growth: a rare entity mimicking desquamative interstitial pneumonia — J. Laforga, A. Gonzalez Garcia (2020)
• Asbestosis and environmental causes of usual interstitial pneumonia — M. Gulati, C.A. Redlich (2015)

Browse return to medical research.