Abstract：
BACKGROUND: Acute fibrinous and organizing pneumonia (AFOP) is a rare clinicopathological condition. Studies in the literature have reported that AFOP may be associated with respiratory infections, such as respiratory syncytial virus, influenza virus, Pneumocystis jirovecii, Penicillium citrinum, and Chlamydia infections. However, AFOP associated with Legionella infection has not been reported previously. Here, we report a case of a patient with AFOP secondary to Sjögren\'s syndrome and Legionella infection.
METHODS: A 47-year-old man was admitted to the hospital because of fever, expectoration, and shortness of breath. Lung imaging showed irregular patchy consolidation. A diagnosis of Legionella pneumonia was initially considered on the basis of the patient\'s history of exposure to soil before disease onset, signs of extrapulmonary involvement, and a positive Legionella urine antigen test result. However, the patient\'s symptoms and lung imaging did not improve after treatment with levofloxacin, moxifloxacin, and tigecycline for Legionella infection. In addition, Sjögren\'s syndrome was diagnosed on the basis of clinical manifestations and immunological indicators. Pathological changes associated with AFOP were confirmed from the results of ultrasound-guided percutaneous lung biopsy. The patient\'s clinical symptoms improved rapidly after a short course of low-dose corticosteroid therapy, and lung imaging showed significant improvement.
CONCLUSIONS: The possibility of secondary AFOP should be considered when Legionella pneumonia does not improve after standard antibiotic therapy. Lung biopsy and histopathological examination are important for the adjustment of treatment strategy. Our case also highlights the importance of screening for autoimmune diseases in patients with AFOP.
METHODS: A 47-year-old man was admitted to the hospital because of fever, expectoration, and shortness of breath. Lung imaging showed irregular patchy consolidation. A diagnosis of Legionella pneumonia was initially considered on the basis of the patient\'s history of exposure to soil before disease onset, signs of extrapulmonary involvement, and a positive Legionella urine antigen test result. However, the patient\'s symptoms and lung imaging did not improve after treatment with levofloxacin, moxifloxacin, and tigecycline for Legionella infection. In addition, Sjögren\'s syndrome was diagnosed on the basis of clinical manifestations and immunological indicators. Pathological changes associated with AFOP were confirmed from the results of ultrasound-guided percutaneous lung biopsy. The patient\'s clinical symptoms improved rapidly after a short course of low-dose corticosteroid therapy, and lung imaging showed significant improvement.
CONCLUSIONS: The possibility of secondary AFOP should be considered when Legionella pneumonia does not improve after standard antibiotic therapy. Lung biopsy and histopathological examination are important for the adjustment of treatment strategy. Our case also highlights the importance of screening for autoimmune diseases in patients with AFOP.
摘要：
背景：急性纤维性和机化性肺炎（AFOP）是一种罕见的临床病理疾病。文献研究报道AFOP可能与呼吸道感染有关，如呼吸道合胞病毒，流感病毒,肺孢子虫jirovecii,柑橘青霉,和衣原体感染。然而,与军团菌感染相关的AFOP以前没有报道。这里,我们报告一例Sjögren综合征和军团菌感染继发AFOP患者。
方法:一名47岁男子因发烧入院,咳痰,呼吸急促.肺部影像学显示不规则斑片状实变。军团菌肺炎的诊断最初是根据患者在发病前暴露于土壤的病史来考虑的。肺外受累的迹象,军团菌尿抗原检测结果呈阳性.然而,左氧氟沙星治疗后，患者的症状和肺部影像学没有改善，莫西沙星,和替加环素治疗军团菌感染.此外,根据临床表现和免疫学指标诊断干燥综合征。超声引导下经皮肺穿刺活检结果证实了与AFOP相关的病理变化。患者的临床症状在短期低剂量皮质类固醇治疗后迅速改善，肺部影像学显示明显改善。
结论：当军团菌肺炎在标准抗生素治疗后没有改善时，应考虑继发性AFOP的可能性。肺活检和组织病理学检查对于调整治疗策略很重要。我们的案例还强调了筛查AFOP患者自身免疫性疾病的重要性。
方法:一名47岁男子因发烧入院,咳痰,呼吸急促.肺部影像学显示不规则斑片状实变。军团菌肺炎的诊断最初是根据患者在发病前暴露于土壤的病史来考虑的。肺外受累的迹象,军团菌尿抗原检测结果呈阳性.然而,左氧氟沙星治疗后，患者的症状和肺部影像学没有改善，莫西沙星,和替加环素治疗军团菌感染.此外,根据临床表现和免疫学指标诊断干燥综合征。超声引导下经皮肺穿刺活检结果证实了与AFOP相关的病理变化。患者的临床症状在短期低剂量皮质类固醇治疗后迅速改善，肺部影像学显示明显改善。
结论：当军团菌肺炎在标准抗生素治疗后没有改善时，应考虑继发性AFOP的可能性。肺活检和组织病理学检查对于调整治疗策略很重要。我们的案例还强调了筛查AFOP患者自身免疫性疾病的重要性。
