ACUTE FIBRINOUS ORGANIZING PNEUMONIA: A NEW ASSOCIATION

TOPIC: Lung Pathology TYPE: Fellow Case Reports INTRODUCTION: Acute Fibrinous and Organizing Pneumonia (AFOP) is a rare histological pattern of acute lung injury unclear etiology. It can present with severe hypoxemia characteristic bilateral basilar infiltrates meeting criteria for respiratory distress syndrome(ARDS). We the case 48-year-old female ARDS who was diagnosed AFOP after an open biopsy. CASE PRESENTATION: A past history schizophrenia, hypertension, type 2 diabetes, osteoarthritis monoclonal gammopathy undetermined significance (MGUS) presented cough progressive shortness breath, worsening acutely over three days. Upon arrival, patient hypoxic oxygen saturation 47%, on room air so she emergently intubated. Initial chest X-ray revealed mid to lower zone concerning pneumonia (Picture 1). Chest CT-Angiogram ruled out pulmonary embolism. She admitted our intensive care unit started empiric broad spectrum antibiotics (Vancomycin/Piperacillin-Tazobactam/Levaquin) ventilated using lung-protective strategy ARDS. Over next 15 days, remained ventilator dependent high FiO2/PEEP requirements eventually had tracheostomy. Microbiological studies including bronchoscopic samples negative. An biopsy performed which showed lymphocyte plasma cell infiltration intra-alveolar fibrin balls absence neutrophil/eosinophil hyaline membrane formation typical other well-recognized patterns injury, leading diagnosis 2). dose steroids (methyprednisolone 60mg IV q8h) prompt resolution improvement in her oxygenation. DISCUSSION: histologic multiple clinical associations but Two have been described: i) fulminant condition ii) subacute illness. Diagnosis requires revealing amidst organizing pneumonia. has described patients HIV infection, decitabine exposure, amiodarone toxicity, post hematopoietic stem transplantation, connective tissue diseases etc. Patients treated corticosteroids, mycophenolate mofetil, cyclophosphamide, cyclosporine variable response. [1] CONCLUSIONS: In this case, unknown represents new association thus adds understanding pathological characteristics disease. REFERENCE #1: 1. fibrinous undifferentiated disease: report. Valim V, Rocha RH, Couto RB, Paixão TS, Serrano EV. Rep Rheumatol. 2012;2012:549298. doi: 10.1155/2012/549298. Epub 2012 Apr 4. DISCLOSURES: No relevant relationships by Sukhmani Boparai, source=Web Response Prangthip Charoenpong, Deon Ford,