A 75-Year-Old Man With Organizing Pneumonia Presenting With Worsening Dyspnea

A 75-year-old man was referred to our institution for worsening dyspnea, decreased activity tolerance, myalgias, and an increase in oxygen requirement. Nine months before the initial referral, the patient presented to an outside hospital for acute hypoxemic respiratory failure requiring a right-sided video-assisted thoracoscopic surgery (VATS) lung biopsy that disclosed organizing pneumonia (OP). He was treated with a prolonged steroid course starting at 1 mg/kg daily and tapered over 6 months to a baseline of 20 mg of prednisone daily and continuous oxygen (2 L/min). Prior attempts to further reduce prednisone resulted in worsening dyspnea, fevers, and myalgias. Despite optimal medical treatment for 3 months, he presented to our institution with progressive dyspnea, an increased oxygen requirement to 6 L/min, fatigue, and muscle weakness.