Bronchiolitis obliterans organizing pneumonia: case report involving a differential diagnosis
DOI:
https://doi.org/10.33448/rsd-v10i12.20133Keywords:
Bronchiolitis obliterans; Adenocarcinoma; Differential Diagnosis; Isolated Opacities; BOOP.Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) is an entity with suggestive clinical and imaging diagnosis associated with evidence of connective tissue on the lumen of the distal air spaces at the lungs. Here we address a case of BOOP and highlight the importance of differential diagnosis. Male patient, 76 years old, ex-smoker (interrupted the habit about 30 years ago), developed complaints of copious and non-productive cough, thermometer fever of 38 ºC and weight loss without relief from the use of fenoterol + ipatropium bromide. There was no recent history of infection, use of systemic or inhaled drugs, or travel. He reported a relevant family history for cancer. Physical examination: patient conscious and comfortable, pale, acyanotic, anicteric, afebrile, eupneic and without signs of respiratory distress with Sat O2 = 98%. Percussion with clear pulmonary sound. Hissing auscultation in pulmonary bases and sparse snoring in the left hemithorax. Spirometric examination with normal parameters, with partial volume variation after the use of bronchodilator. The high-resolution computed tomography (HRCT) of the chest showed areas of consolidation in the alveolar air space, bilateral and asymmetric, with predominance in the peribronchial regions, some assuming the appearance of pulmonary nodules surrounded by ground glass. Later, in the differential diagnosis, positron emission tomography-computed tomography (PET-CT) revealed an inflammatory process in the resolving phase, ruling out other diseases, for example, pulmonary adenocarcinoma. We opted for the prescription of Prednisone and the follow-up of the condition with chest X-rays, which, after 4 months, showed patterns within the normal range. Currently, the patient is “well” and with total remission of symptoms and under continuous therapy.
References
Addor, G., Monteiro, A., Nigri, D.H, et al. (2004). Bronquiolite Obliterante com Pneumonia em Organização. J Bras Pneumol, 30(2), 154-157.
Akira, M., Yamamoto, S., Sakatani, M. (1998). Bronchiolitis obliterans organizing pneumonia manifesting as multiple large nodules or masses. AJR, 170, 291-295.
Alsaghir, A. H., Al-Mobeireek, A. F., Al-Jahdali, H., et al. (2007). Bronchiolitis obliterans organizing pneumonia: experience at three hospitals in Riyadh. Ann Saudi Med, 27(1), 32-5.
Cazzato, S., Zompatori, M., Baruzzi, G., et al. (2000). Bronchiolitis obliterans-organizing pneumonia: an Italian experience. Respir Med, 94(7), 702-8.
Cordier, J-F. (2006). Cryptogenic organising pneumonia. Eur Respir J, 28, 422–446.
Cornelissen, R., Senan, S., Antonisse, I. E., et al. (2007). Bronchiolitis obliterans organizing pneumonia (BOOP) after thoracic radiotherapy for breast carcinoma. Radiation Oncology, 2, 2.
Davison, A. G., Heard, B. E., McAllister, W. A. C., et al. (1983). Cryptogenic organizing pneumonitis. Q J Med, 207, 382–394.
de Almeida, P., Guimarães, M. J. B., Costa, M. G., et al. (2002). Bronquiolite obliterante na forma nodular. J Pneumol, 28(6), 335-8.
Drakopanagiotakis, F., Polychronopoulos, L., Judson, M. A. (2008). Organizing pneumonia. The American Journal of the Medical Sciences, 355(1), 34-39.
Epler, G.R., Colby, T.V., McLoud, T.C., et al. (1985). Bronchiolitis obliterans organizing pneumonia. N Engl J Med, 312, 152–158.
Fonseca, L., Meruje, M., Barata, F., et al. (2007). Bronchiolitis obliterans organizing pneumonia – Experience of pulmonology Ward. Revista Portuguesa de Pneumologia, 13(3), 301-318.
Fonti, R., Conson, M., Del Vecchio, S. (2019). PET/CT in radiation oncology. Semin Oncol, 46(3), 202-209.
Jhayya, T. S., Perez, D. B., Llarges, C. M., et al. (2000). Bronquiolite obliterante com pneumonia em organização e aspergiloma em paciente com linfoma-leucemia de células T. J Pneumol, 26(1), 52-54.
Kitaichi, M. (1992). Differential diagnosis of bronchiolitis obliterans organizing pneumonia. Chest, 102(1), 44S-49S.
Kim, I., Lee, J. E., Kim, K-H., et al. (2016) Successful treatment of suspected organizing pneumonia in a patient with Middle East respiratory syndrome coronavirus infection: a case report. J Thorac Dis, 8(10), E1190-E1194.
Kory, P., Kanne, J. P. (2020). SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’. BMJ Open Resp Res, 7, e000724.
Lazoir, R., Vandevenne, A., Pelletier, A., et al. (2000). Cryptogenic organizing pneumonia: characteristics of relapses in a series of 48 patients. Am J Crit Care Med, 162, 571-577.
Leung, C. W., Chiu, W. K. (2004). Clinical picture, diagnosis, treatment and outcome of severe acute respiratory syndrome (SARS) in children. Paediatric Respiratory Reviews, 5, 275–288.
Moraes, H. R. S., Barboza, M. H. D., Tucci, J. A., Neto, J. B., Carvalho, L. F., Cerdeira, C. D., Souza, M. M. M. H. (2021). Bronquiolite obliterante em paciente pediátrico associada com exposição à cocaína e outras drogas de abuso durante o período gestacional. Research, Society and Development, 10(9), e35210918021.
Muller, N., Fraser, R., Lee, K., et al. (2004). Doenças do Pulmão: Correlação Radiológica e Patológica. Ed. Revinter, 1ª edição.
Oymak, F., Demirbaş, S. H., Mavili, M. E., et al. (2005). Bronchiolitis obliterans organizing pneumonia: clinical and roentgenological features in 26 cases. Respiration, 72(3), 254-62.
Santos, M. L. O., Marchiori, E., Vianna, A. D., et al. (2003). Opacidades em vidro fosco nas doenças pulmonares difusas: correlação da tomografia computadorizada de alta resolução com a anatomopatologia. Radiol Bras, 36, 329-338.
Tse, G.M-K., To, K-F., Chan, P.K-S., et al. (2004). Pulmonary pathological features in coronavirus associated severe acute respiratory syndrome (SARS). J Clin Pathol, 57, 260–265.
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Copyright (c) 2021 Hiago Pereira Macedo; João Marcelo Lobo; Matheus Henrique Defendi Barbosa; Mirian Nomura da Silva; Pollyana Rodrigues Reis; Wandyk Allisson Bernardes Pereira; Cláudio Daniel Cerdeira; Fábio Antônio Gomes; Gérsika Bitencourt Santos Barros
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