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Acute Fibrinous Organizing Pneumonia: A Case Report and Literature Review
Bryan A Garcia1, Timothy Goede2, Tan-Lucien Mohammed2
1Department of Internal Medicine, University of Florida, Gainesville, FL.
Abstract:
Acute fibrinous organizing pneumonia (AFOP) is a distinct histopathologic pattern of lung injury with the hallmark feature of intra-alveolar fibrin deposits with associated organizing pneumonia, type II pneumocyte hyperplasia, and a patchy lymphohistiocytic proliferation. We describe the case of a previously healthy 47-year-old man who presented with a 4-day history of worsening dyspnea, cough, and nocturnal fevers and miliary nodules on chest imaging. Subsequently, there was an indication of AFOP when he underwent open lung biopsy. AFOP has been associated with a variety of underlying conditions including rheumatologic diseases, medications, and infections, and several cases were idiopathic. This case highlights the importance for radiologists to be aware of this uncommon pattern of lung injury and to consider it in the differential when encountering bilateral miliary infiltrates on chest imaging.
Insights
Acute fibrinous organizing pneumonia (AFOP) is a rare lung injury pattern. This case emphasizes recognizing AFOP in patients with miliary nodules for timely diagnosis and treatment.
Area of Science:
- Pulmonary Medicine
- Pathology
Background:
- Acute fibrinous organizing pneumonia (AFOP) is a specific histopathologic lung injury pattern.
- It is characterized by intra-alveolar fibrin, organizing pneumonia, and pneumocyte hyperplasia.
Observation:
- A previously healthy 47-year-old man presented with acute dyspnea, cough, and fevers.
- Chest imaging revealed miliary nodules, prompting further investigation.
Findings:
- Open lung biopsy confirmed the diagnosis of AFOP.
- AFOP can be associated with rheumatologic diseases, medications, infections, or be idiopathic.
Implications:
- Radiologists should consider AFOP in the differential diagnosis for bilateral miliary infiltrates.
- Early recognition of AFOP is crucial for appropriate patient management.
