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Unusual presentation of more common disease/injury
CASE REPORT
Acute fibrinous organising pneumonia presenting as a cavitary lung lesion and treatment response to azithromycin
  1. Waqas Aslam1,
  2. Francisco Perez-Guerra1,
  3. Deborah Jebakumar2,
  4. Daniel A Culver3 and
  5. Shekhar Ghamande1
  1. 1 Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott & White Medical Center, Texas A & M University, College of Medicine, Temple, Texas, USA
  2. 2 Department of Pathology and Laboratory Medicine, Baylor Scott & White Medical Center, Texas A & M University, College of Medicine, Temple, Texas, USA
  3. 3 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Waqas Aslam, drwaqasaslam{at}yahoo.com

Abstract

Acute fibrinous organising pneumonia is distinct from the classic diffuse alveolar damage, organising pneumonia and eosinophilic pneumonia. A 52-year-old woman presented with fever, productive cough, night sweats and left-sided pleuritic chest pain for a week. Physical examination was significant only for decreased breath sounds in the left infraclavicular area laterally. Imaging studies revealed a peripheral thick-walled left upper lobe cavitary lesion, left lower lobe consolidation and an enlarged subcarinal lymph node. She was treated with doxycycline for 10 days without improvement. Pertinent laboratory tests, microbiologic workup and fibre-optic bronchoscopy were non-diagnostic and a CT-guided left upper lobe lung biopsy revealed acute fibrinous organising pneumonia. She was treated with azithromycin with complete resolution of symptoms. To our knowledge, this is the first reported case of acute fibrinous organising pneumonia presenting as a cavitary lung lesion and the first with treatment response to azithromycin.

  • pneumonia (respiratory medicine)
  • infections
  • pathology
  • radiology

https://doi.org/10.1136/bcr-2019-230868

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    Footnotes

    • Contributors WA and FP-G: involved in direct patient care with full access to the patient data and drafted the initial manuscript. DJ: helped in drafting pathology portion of the manuscript including histopathology slides. FP-G, DAC and SG: reviewed the manuscript, provided feedback and helped in the final editing of the manuscript. WA: followed up with the patient.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Patient consent for publication Obtained.