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Published 27 February 2009
Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.08.2008.0809]
Copyright © 2009 by the BMJ Publishing Group Ltd.

Unusual association of diseases/symptoms

Bilateral pulmonary nodules in an adult patient with bronchiolitis obliterans-organising pneumonia

Antonios Kopanakis1, Christos Golias2, Michalis Patentalakis2,3, Christos Mermigkis3, Alexandros Charalabopoulos2, Dimitrios Peschos4, Anna Batistatou4, Konstantinos Charalabopoulos2

1 Department of Intensive Care, Edessa State Hospital, Fidiou 9 Street, Edessa, 45500, Greece
2 Medical Faculty, University of Ioannina, Department of Physiology, Clinical Unit, 13 Solomou Street, Ioannina, 45221, Greece
3 Sismanoglion Hospital, Department of Occupational Lung Diseases and Tuberculosis, 13 Solomou Street, Ioannina, 45221, Greece
4 Medical Faculty, University of Ioannina, Department of Pathology, 13 Solomou Street, Ioannina, 45221, Greece

Correspondence to:
kcharala{at}cc.uoi.gr

SUMMARY

A 58-year-old male ex-smoker was admitted to hospital because of nodular infiltrates on chest x rays. He was complaining of fatigue, dyspnoea with exertion, low grade fever and weight loss. Physical examination was unremarkable. Bronchoscopy was inconclusive but revealed endobronchial lesions of chronic active inflammation. The diagnosis of cryptogenic organising pneumonitis bronchiolitis obliterans-organising pneumonia (COP-BOOP) was established by open lung biopsy. Proliferative bronchiolitis with regions of organising pneumonia is the characteristic feature of COP. The radiological picture of bilateral pulmonary nodules is an infrequent manifestation of COP. Lung biopsy, open or with video assistance thoracic surgery, is recommended to confirm the diagnosis.


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