BMJ Case Reports 2017; doi:10.1136/bcr-2016-218802
  • Rare disease

Acute fibrinous and organising pneumonia

  1. Leila Cardoso1
  1. 1Serviço de Medicina Interna B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  2. 2Serviço de Anatomia Patológica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  1. Correspondence to Dr João Rocha Gonçalves, jrochagoncalves{at}
  • Accepted 5 May 2017
  • Published 7 September 2017


Acute fibrinous and organising pneumonia (AFOP) is a rare histological pattern of interstitial lung disease. The authors describe a 60-year-old woman admitted to the hospital for sustained fever, presenting with an alveolar opacity on chest X-ray, with the presumed diagnosis of community-acquired pneumonia and the onset of antibiotics. Since serological results suggested that Legionella pneumophila was the infectious agent, she was discharged on levofloxacin. A week later, she was again admitted with fever. CT scan showed opacities with crescentic morphology and a central ground-glass area suggestive of cryptogenic organising pneumonia. Microbiological, serological and autoimmunity tests were negative. She underwent surgical lung biopsy that revealed inflammatory infiltrate, macrophage desquamation, fibroblasts proliferation and fibrin deposition in the alveolar spaces, consistent with AFOP. She started corticotherapy with good response. Disease relapsed after prednisolone discontinuation, 10 months later. Currently, the patient is on prednisolone 5 mg/day without clinical and radiological recurrence.


  • Contributors The authors authorise the publication of the following article in the BMJ Case Reports, stating that it has not been published nor is it awaiting publication in another journal. The four authors declare that they have contributed in the elaboration of the article according to the ICMJE Recommendations. JRG and RM: conception and design, acquisition of data or analysis and interpretation of data. JRG, RM, PS and LC: drafting the article and revising it critically for important intellectual content. JRG, RM, PS and LC: final approval of the version published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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