Bronchiolitis obliterans organizing pneumonia cured by standard dose inhaled triamcinolone: the first documented case

Bronchiolitis obliterans organizing pneumonia (BOOP) is characterized clinically by progressive cough, fever, and dyspnea and pathologically by plugging of the bronchiolar and alveolar lumen with buds of loose connective tissue containing fibroblasts and inflammatory cells. The radiographic appearance of the disease varies. Definitive diagnosis requires the histologic identification of the disease in the appropriate clinical setting. Tissue may be obtained by bronchoscopy, needle biopsy, or open lung biopsy. BOOP is responsive to oral corticosteroids, which are the mainstay of therapy. We report the case of a 30-year-old white woman who had BOOP diagnosed in 1991 after extensive therapy for stage II nodular sclerosis Hodgkin's disease. Appropriate treatment of this patient would have been oral corticosteroids for 6 to 12 months, but the patient refused because of a history of significant steroid side effects. Inhaled triamcinolone (3 puffs 4 times per day by metered dose inhaler) for 8 months resulted in complete resolution of the disease. We believe this is the first documented case of clinical and histopathologically confirmed BOOP cured with inhaled corticosteroids.