Original contributions: Case reports in transplantationThoracicA Case of Acute Fibrinous and Organizing Pneumonia During Early Postoperative Period After Lung Transplantation
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
References (12)
- et al.
Distinct histopathology of acute onset or abrupt exacerbation of hypersensitivity pneumonitis
Hum Pathol
(2012) - et al.
Acute fibrinous and organizing pneumonia
Rev Port Pneumol
(2006) - et al.
An official American Thoracic Society/European Respiratory Society Statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias
Am J Respir Crit Care Med
(2013) - et al.
Acute fibrinous and organizing pneumonia: a histologic pattern of lung injury and possible variant of diffuse alveolar damage
Arch Pathol Lab Med
(2002) - et al.
Acute fibrinous and organizing pneumonia as a rare presentation of abacavir hypersensitivity reaction
AIDS
(2007) - et al.
Acute fibrinous and organizing pneumonia in a patient with collagen vascular disease “stigma”
Sarcoidosis Vasc Diffuse Lung Dis
(2007)
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Subacute pneumonia as a manifestation of acute fibrinous and organizing pneumonia
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2016, Radiologic Clinics of North AmericaCitation Excerpt :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 CareCitation Excerpt :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.
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