Original contributions: Case reports in transplantation
Thoracic
A Case of Acute Fibrinous and Organizing Pneumonia During Early Postoperative Period After Lung Transplantation

https://doi.org/10.1016/j.transproceed.2015.02.002Get rights and content

Highlights

  • The early postoperative period after lung transplantation complicates with several conditions.

  • AFOP is related to CLAD but may be seen in the early postoperative period.

  • Transbronchial biopsy plays a central role in the differential diagnosis.

Abstract

Acute fibrinous and organizing pneumonia (AFOP) is a distinct histologic pattern usually classified under the term chronic lung allograft dysfunction. We present a 48-year-old female patient who experienced AFOP during the 2nd week of double lung transplantation for pulmonary Langerhans cell histiocytosis and secondary pulmonary hypertension. During the 8th day after transplantation, fever and neutrophilia developed together with bilateral consolidation. Infection markers were elevated. Despite coverage of a full antimicrobial spectrum, the situation progressed. The patient was diagnosed with AFOP with transbronchial biopsy. The infiltration resolved and the patient improved dramatically with the initiation of pulse corticosteroid treatment. AFOP should be suspected when there is a pulmonary consolidation after lung transplantation, even in the very early post-transplantation period. Several causes, such as alveolar damage and drug reactions, should be considered in the differential diagnosis.

Section snippets

Case Presentation

The patient was a 48-year-old woman who had undergone double lung transplantation surgery indicated for pulmonary Langerhans cell histiocytosis and secondary pulmonary arterial hypertension. The patient was discharged from the operation room to the intensive care unit with venoarterial extracorporeal membrane oxygenator (ECMO) which was constituted peripherally through the femoral vein and artery. T- and B-cell crossmatch was negative. She received alemtuzumab induction followed by initiation

Discussion

The early postoperative period after lung transplantation is usually a great challenge for a transplant team, with several distinct complications. Especially, infiltration on chest roentgenography after lung transplantation needs considerable attention to differential diagnostic work-up and immediate management strategies. Several conditions may lead to an opaque lung, but fortunately they usually occur in relatively specific time periods (Fig 4). For example, primary graft dysfunction usually

Conclusion

Acute fibrinous and organizing pneumonia should be suspected and rapidly investigated when there is a pulmonary consolidation after lung transplantation even in the very early post-transplantation period. It mimics infection and acute rejection with clinical, radiologic, and biochemical features. Differential diagnosis usually relies on histologic evaluation. As in the present case, it may result in a life-threatening condition and yet is an underdiagnosed entity possibly due to a “tissue

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Cited by (16)

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    Tissue sampling is necessary for definitive diagnosis. Corticosteroids are standard therapy, and prognosis is variable.59 Infection in the late posttransplant period is commonly secondary to opportunistic organisms, including fungal, viral, and mycobacterial infections.

  • Life after acute fibrinous and organizing pneumonia: a case report of a patient 30 months after diagnosis and review of the literature

    2016, Journal of Critical Care
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    In 8 patients, 7 of whom underwent transbronchial biopsy [3,4,6,9,33,41,47] and 1 who had a transthoracic biopsy [31], the results were inconclusive and required further diagnostic work up. The diagnosis of AFOP was made by surgical lung biopsy in 52 patients, transbronchial lung biopsy in 9 patients, percutaneous needle biopsy in 2 patients, image-guided (CT- or ultrasound-guided) percutaneous lung biopsy in 8 patients, peripheral lung biopsy in 1 patient, unspecified lung biopsy techniques in 3 patients, and autopsy in 10 patients [1–50]. Our patient’s BAL and bronchoscopic biopsy were inconclusive; the diagnosis was made with surgical lung biopsy.

  • Cryptogenic organising pneumonia: A clinic case

    2017, Acta Colombiana de Cuidado Intensivo
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