A case of bronchiolitis obliterans organising pneumoniae (BOOP) after nine months post-operative irradiation for breast cancer.

A 71-year-old woman was referred to our unit with fever (38.5◦C). During the preceding 3 weeks she reported sweats and non-productive cough despite previous antibiotic therapy. In May 2005 she had undergone a quadrantectomy and sentinel-node biopsy at our hospital for right upperouter quadrant breast cancer. She received radiation therapy through conventional tangential-field irradiation using photons from August to September 2005. Chest X-ray showed a right-sided pulmonary area of consolidation. CT scan demonstrated dense pneumonic infiltrate with bronchograms in the right mid-lobe. A second CT scan (21 days after the first) (see Figure 1a in the supplementary data on the journal’s website http://www.ageing.oxfordjournals.org) showed patchy consolidation in the right mid-lobe and the appearance of bilateral nodules (diameter 1–2 cm) at the posterior segment of the right upper lobe. The patient underwent lung biopsies via bronchoscopy at the midand upper right lobes from the radiographically abnormal area. Histology confirmed the diagnosis of bronchiolitis obliterans organising pneumoniae (BOOP). After oral prednisone there was a dramatic resolution of respiratory symptoms within 1 week, and a CT scan (see Figure 1b in the supplementary data on the journal’s website http://www.ageing.oxfordjournals.org) 3 weeks after initiating steroid therapy, showed resolution of the right area of consolidation. This case implies that BOOP should always be kept in mind when treating patients who present these types of symptoms following irradiation of the breast [1–3].