Objective To highlight the characteristics of acute fibrinous and organizing pneumonia ( AFOP) . Methods The clinical, radiological and pathological data of two patients with AFOP were analyzed, and relevant literature was reviewed. Results Two male patients with the age of 48 years and 43 years presented with fever, cough, dyspnea and chest pain. The chest CT scan revealed multiple, bilateral, patchy consolidation distributing in peripheral areas in one case and consolidation in the middle lobe of the right lung and a little pleural effusion in another case. Two patients were diagnosed initially as community acquired pneumonia, but antibiotic treatment was ineffective. After the transbronchial lung biopsy and computed tomography guided percutaneous lung biopsy, pathological examination revealed there were numerous fibrin and organizing tissue in the alveoli without pulmonary hyaline membrane, which were consistent with AFOP. The patients showed significant clinical and radiological improvement after corticosteroid therapy. One patient was stable and the other one died of respiratory failure because of relapse during dose reduction of corticosteroids. Conclusions Patients of AFOP were misdiagnosed as pneumonia easily. Treatment with corticosteroids could be effective to some patients. If the antibiotic treatment was ineffective to the patient with fever and consolidation in the lungs, AFOP should be considered in the differential diagnosis.
ObjectiveTo analyze the clinical characteristics of patients with amyopathic dermatomyositis with organizing pneumonia (ADM-OP).MethodsThe clinical data of 8 patients hospitalized with ADM-OP from June 2014 to June 2018 were retrospectively reviewed and simultaneously compared with those of 8 patients of cryptogenic organizing pneumonia (COP).ResultsThe incidence of skin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies in the ADM-OP patients were 87.5%, 87.5% 75.0% and 87.5% respectively. Gender, smoking, respiratory symptoms and signs, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide and treatment strategy were no statistical difference between ADM-OP and COP patients, but the onset age and Chest CT fibrosis scores (CTFS) on admission existed differences. After treatment for 3 months, CTFS, rate of change and forced vital capacity (FVC) existed differences. After treatment for 6 months, CTFS, rate of change, FVC and diffusing capacity of the lung for carbon monoxide existed differences.ConclusionsSkin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies are more common in ADM-OP patients. Their response to treatment is good but the improvement rates in CTFS and pulmonary function are slower than those of COP patients.
ObjectiveTo improve clinicians' awareness of cryptogenic organizing pneumonia (COP).MethodsThirty-three inpatients with COP, who had been diagnosed by pathology in Nanjing Drum Tower Hospital during January 2013 to December 2016 were collected. Their clinical manifestations, laboratory tests and imaging data were reviewed and analyzed retrospectively.ResultsThirty-three cases consisted of 18 males and 15 females, and the mean age was (58.7±13.5) years old. Most patients had subacute or insidious onset. The common symptoms were cough, fever, shortness of breath and chest tightness. About half of patients revealed inspiratory crackles or velcroes. Autoantibodies and anti-neutrophil cytoplasmic antibodies were negative. High-resolution computerized tomography findings of COP included bilateral patchy areas of air-space consolidation that showed predominantly subpleural or peri-bronchovascular distribution, focal nodules, enlarged hilar or mediastinal lymph nodes and pleural effusion. 25 patients were treated with glucocorticoid, 6 with macrolid, and 2 were only followed up without drug treatment.ConclusionsClinical manifestations, laboratory tests and imaging features are important clues to diagnose COP. Diagnosis depends on pathology. Meanwhile, definite pathogen and potential underlying diseases must be excluded.
ObjectiveTo systematically analyze prognostic factors in acute fibrinous and organizing pneumonia (AFOP) and provide evidence for optimizing clinical management strategies for improved patient outcomes. MethodsWe searched the Medline, Web of Science, CNKI and Wanfang databases to identify studies that met predefined criteria, from which we extracted individual patient data (IPD). Clinical characteristics were compared among groups (Survival without recurrence, Survival with recurrence, Death, Lung transplantation) using univariate analysis. Additionally, the Random Forest model was employed to assess the importance of factors associated with these prognostic outcomes. ResultsIPD, which were extracted from 179 patients across 130 studies, were analyzed. Intergroup comparisons revealed that the death group exhibited the highest rate of combined antibiotic-glucocorticoid therapy, with the earliest glucocorticoid initiation, highest doses, yet shortest treatment duration, a profile likely reflecting confounding by indication due to more rapidly progressive disease. After excluding hyper-acute cases, restricted cubic spline (RCS) analysis further suggested that earlier initiation of corticosteroid therapy (within 0-15 days) was associated with a lower risk of death. Diagnostic delay was also significantly associated with poor outcomes (P=0.015). The average diagnostic delay was significantly higher in the death group than the survival without recurrence group (42.4 days vs. 26.2 days). Hematologic diseases were the most frequent comorbidity among both survivors and non-survivors, occurring more often in the death group (39.5%, 15/38) than in the survival group (14.7%, 17/116). Random Forest analysis identified the treatment regimens as the most significant predictors of prognosis, likely reflects confounding by indication, followed by diagnostic delay, age, duration of corticosteroid maintenance, and time from symptom onset to corticosteroid therapy.ConclusionThe treatment regimen, diagnostic delay, and timing of therapeutic intervention are key factors influencing AFOP prognosis. These findings suggest that clinical practice should focus on shortening the diagnostic delay to achieve prompt diagnosis and initiate glucocorticoid therapy accordingly. However, treatment regimens must be individualized based on the patient’s age, underlying diseases, and disease severity.
ObjectiveTo retrospectively analyze the clinical,pathological and imaging features of one case pathologically diagnosed as cryptogenic organizing pneumonia(COP) to improve clinical diagnosis and treatment. MethodsWith a case report and review of the related literatures,the clinical manifestations,radiological features,pathological features,differential diagnosis,management and prognosis of COP were discussed. ResultsThe clinical manifestations of COP had no specificity. The imaging manifestations were real shadows,ground glass shadows,nodules and all kinds of tape. Pathological features of lung specimen biopsy showed buds of granulation tissue within alveolar ducts and alveoli consisting of fibroblasts. Remarkable response to corticosteroids was found in this patient. The prognosis of COP was good. ConclusionsCOP is diagnosed on basis of clinical,pathologic,and imaging findings. The radiological features of COP which show mass with cavity are rare. It can be easy misdiagnosed as lung infection or tumor. The effects of ordinary anti-bacteria therapy are limited,while the corticosteroids therapy shows preferable effects. Therefore,it's important to acquire pathological evidences as early as possible to guide the diagnose and treatment.
Objective To improve the knowledge of cryptogenic organizing pneumonia ( COP) , and reduce misdiagnosis and mistreatment. Methods The medical records of 22 patients with biopsy-proven COP from January 2006 to October 2011 were retrospectively reviewed. The clinical presentation, laboratory data, radiographic results and treatment were collected and analyzed. Results The clinical presentations were nonspecific, and the most common symptomof COPwas cough ( 95. 45% ) . The laboratory data analysis revealed that elevated erythrocyte sedimentation rate in 71. 43% of the COP patients. The COP patients usually presented with a restrictive ventilation dysfunction and decreased diffuse function on pulmonary function test. The most common patterns of lung abnormality on chest CT scan were bilaterally multifocal patchy consolidation or ground-glass opacification ( 63. 64% ) , which distributed along the bronchovascular bundles or subpleural lungs. Patchy consolidation with air bronchograms was also a common feature ( 54. 55% ) . Migration over time and spontaneous remission of consolidation were important pointers.Histopathology by transbronchial lung biopsy was a valuable means for diagnosis. The majority of COP patients were non-response to antibiotics, but responded rapidly and completely to oral administration of corticosteroids with good prognosis. Conclusions The clinical presentations and laboratory data of COP patients are nonspecific. Initial imaging findings of COP are similar with pneumonia. Strengthening the recognition of COP is conducive to reducing misdiagnosis and reasonable antibiotics use.