Acute Fibrinous and Organizing Pneumonia with Excellent Response to Steroid Therapy

Abstract

Acute Fibrinous and Organizing Pneumonia (AFOP) is a diffuse infiltrative pulmonary disease characterized by the presence of intra alveolar fibrin and organized pneumonia. It’s a rare and relatively unknown "entity" with only a few cases described. Herein, we describe the association of acute fibrinous and organizing pneumonia with excellent response to steroid therapy. We suggest that, such an association has been very rarely reported. A32 year's old Sudanese female was presented to us in ELmek Nimer university hospital complaining of fever, cough and shortness of breath for 10 days and received a full course of antibiotics without any improvement, her condition deteriorated. The initial chest radiography showed well defined inhomogeneous pacification in the upper lobe of the left lung with no air bronchogram, Computed Tomography of the chest showed a rather well defined Lt Upper lobe mass lesion closely related to the arch of the aorta. Ultrasound guided biopsy of the lung showed a histological diagnosis of acute fibrinous and organizing pneumonia. After establishing the diagnosis of fibrinous pneumonia the patient received oral steroid (prednisone 1mg/kg) for 10 days then tapering. The patient showed rapid improvement and excellent response and discharged in good condition. Chest radiography after one month showed complete resolution of the radiological finding in her previous imaging. We recommend that AFOP should be considered in the differentials of a suspected pulmonary infection unresponsive to optimal antibiotic "therapy". AFOP may present as pulmonary mass on chest X-ray and diagnosed made with biopsy and histological examination. We conclude that AFOP may be treated with "steroids" therapy.