PMC5140866_01
(A) Chest X-ray showed a consolidation in the right lower lung field at the time of admission. (B) The consolidation rapidly worsened and developed in both lungs on Day 4 of hospitalization.
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A chest X-ray showed consolidation in the right lower lung field and the patient was admitted to our hospital (Fig. 1A). He was transferred to the intensive care unit (ICU) with mechanical ventilation (Fig. 1B).
Chest X-ray indicated residue of the consolidation in both lungs on Day 11 of hospitalization, when the patient's respiratory status improved and mechanical ventilation was removed.
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The corticosteroid dosage was increased to prednisolone (60 mg/day) on day 9 of hospitalization, and he was successfully weaned from mechanical ventilation on day 11 without additional immunosuppressive agents (Fig. 2).
(A) Trans-bronchial lung biopsy on Day 15 showed abundant fibrin exudate, immature organization in the alveolar spaces, and lymphoplasmacytic infiltration in the alveolar septa [A-1: Hematoxylin and Eosin (H&E) staining, original magnification 100x, A-2: H&E staining, original magnification 400x, A-3: Masson, original magnification 400x]. (B) Trans-bronchial lung biopsy on Day 42 of hospitalization showed infiltration of fibroblasts and organization without fibrin exudate (B-1: H&E staining, original magnification 100x, B-2: H&E staining, original magnification 400x, B-3: Masson, original magnification 100x, B-4: Masson, original magnification 400x). Masson: Masson trichrome stain
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AFOP, namely, abundant fibrin exudate, immature organization in the alveolar spaces, and lymphoplasmacytic infiltration in the alveolar septa (Fig. 3A). The consolidation in the right lower lobe persisted, despite prolonged corticosteroid treatment, possibly suggesting another complication such as a fungal infection. A second TBLB performed on day 42 revealed the replacement of these features by fibroblasts and evidence of organization, which are the histological features of OP (Fig. 3B).
Chest X-ray on 52 day of hospitalization showed that the consolidation in the right lower lung field significantly improved. The patient was discharged from our hospital following these findings.
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The diagnosis of AFOP and OP was made based on the histological and clinical signs. The dosage of the prednisolone was tapered to 7 mg/day when the patient recovered and was discharged on day 52 of hospitalization (Fig. 4).