PMC3420729_01
(a) and (b) CT findings of "focal areas of lung parenchymal infiltrates with ground-glass opacities, associated (white arrow) with septal thickening (yellow arrow), with peripheral distribution." (c) and (d) CT findings of interstitial infiltrate, with diffuse ground glass opacity with foci of parenchymal densification (yellow arrow) and some air bronchograms (white arrow). (e) Histhopatological examination showing (1) intra-alveolar accumulation of fibrin in the form of solid blocks; (2) acute inflammatory infiltrate in the interstitium; (3) alveolar septal edema and congestion; (4) xantomatososum macrophages accumulation.
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Initial diagnosis by pulmonologist was "organizing pneumonia," based on clinical history and computed tomographic (CT) findings, described as "focal areas of lung parenchymal infiltrates with ground-glass opacities, associated with septal thickening, with peripheral distribution, predominating in the lower lobes" (Figures 1(a) and 1(b)). Small calcified nodules of residual aspect, scattered in both lungs, without pleural effusion (Figures 1(c) and 1(d)), were observed. Histopathological examination showed "a parenchymal diffuse involvement, intra-alveolar fibrin accumulation in the form of solid blocks, pneumocytes hyperplasia, interstitial mild acute inflammatory infiltrate, alveolar septal edema and congestion, intra-alveolar fibroblastic Masson bodies and xantomatososum  accumulation of macrophages, a typical pattern of acute Fibrinous and Organizing Pneumonia (AFOP)" (Figure 1(e)).
Panoramic nailfold capillaroscopy of the left and right fourth digits showing a scleroderma standard microangiopathy: dilated capillaries and devascularization areas.
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