背景:急性纤维性和机化性肺炎(AFOP)是一种罕见的急性或亚急性间质性肺病,其特征是肺泡内纤维蛋白的沉积和具有斑片状分布的机化性肺炎。AFOP的临床特征是非特异性的,它经常被误诊为肺炎,癌症,结核病,或其他肺部疾病。
方法:在本案例报告中,一名58岁的女性出现胸闷,呼吸急促,咳嗽和痰。胸部CT扫描显示双肺有多个斑片状阴影。她最初被诊断为社区获得性肺炎。她的纯化蛋白衍生物皮试呈阳性,但痰中的抗酸杆菌呈阴性。
方法:通过支气管镜肺活检和组织病理学诊断为AFOP。
方法:AFOP诊断后,所有抗感染药物都停用了,用甲基强的松龙和强的松代替。
结果:甲基强的松龙40mg/d治疗1周后,患者胸部CT及临床症状改善。一个月后,患者症状有显著改善,CT扫描显示双肺病灶完全吸收.经过5个月的随访,患者症状完全消失。
结论:急性AFOP是一种罕见的肺部疾病,预后不良;因此,早期诊断和鉴别尤为重要。明确诊断需要组织病理学发现。目前,AFOP没有统一的治疗指南,必须根据每个患者的病因和严重程度来定制治疗方法。亚急性AFOP对皮质类固醇治疗有良好的反应。
BACKGROUND: Acute fibrinous and organizing pneumonia (AFOP) is a rare acute or subacute interstitial lung disorder characterized by the deposition of fibrin within the alveoli and organizing pneumonia with a patchy distribution. The clinical features of AFOP are nonspecific, and it is often misdiagnosed as pneumonia, cancer, tuberculosis, or other lung disorders.
METHODS: In this case report, a 58-year-old woman presented with chest tightness, shortness of breath, cough and sputum. A chest CT scan showed multiple patchy shadows in both lungs. She was initially diagnosed with community-acquired pneumonia. Her purified protein derivative skin test was positive, but sputum was negative for acid-fast bacilli.
METHODS: AFOP was diagnosed by bronchoscopic lung biopsy and histopathology.
METHODS: Following AFOP diagnosis, all anti-infective drugs were discontinued, and replaced by methylprednisolone and prednisone.
RESULTS: After 1 week of treatment with methylprednisolone 40 mg daily, the patient chest CT and clinical symptoms improved. After 1 month, the patient symptoms had demonstrated dramatic improvement and CT scan revealed complete absorption of lesions in both lungs. After 5 months of follow-up, the patient symptoms completely disappeared.
CONCLUSIONS: Acute AFOP is an uncommon lung condition with poor prognosis; hence, early diagnosis and identification are particularly important. Definitive diagnosis requires histopathological findings. Currently, there is no unified treatment guideline for AFOP, and treatment must be tailored based on the etiology and severity of each individual patient disease. Subacute AFOP shows a good response to corticosteroid treatment.