[What the Hookah hides: An unknown cause of acute organized fibrinous pneumonia?]

Acute organized fibrinous pneumonia (AOFP) is a rare entity, initially characterized by Beasley et al. in 2002. This report highlights an undocumented case of AOFP in a habitual hookah smoker. AOFP is distinguished by inflammatory infiltrates and intra-alveolar fibrin deposits, often associated with infectious and autoimmune processes, and recently linked to the use of electronic cigarettes and vaping. The involvement of hookah in this pathogenic mechanism suggests that inhalation of oil-rich compounds and high-temperature gases could cause similar alveolar damage. Early recognition of AOFP is essential in patients presenting with sudden dyspnea and pulmonary infiltrates unresponsive to antibiotic therapy. Diagnosis relies on biopsies confirming fibrin deposits, and prompt treatment with corticosteroids can lead to effective clinical and radiological resolution.