Exploring Diverse Presentations of Cryptogenic Organizing Pneumonia: A Case Series

Case Series

Austin J Pulm Respir Med. 2023; 10(2): 1099.

Exploring Diverse Presentations of Cryptogenic Organizing Pneumonia: A Case Series

Ramana Prasad VV¹*; Chirali Shah²; Kranthi Kumar²

¹Department of Pulmonology, KIMS Krishna Institute of Medical Sciences, India

²Senior Resident, Department of Pulmonology, Krishna Institute of Medical Sciences and Research, Minister Road, Secunderabad 500003

*Corresponding author: Ramana Prasad VV Department of Pulmonology, KIMS Krishna Institute of Medical Sciences, India. Email: ramanaprasadpulmo@gmail.com

Received: June 26, 2023 Accepted: August 02, 2023 Published: August 09, 2023

Abstract

Cryptogenic Organizing Pneumonia (COP), the idiopathic form of Organizing Pneumonia (OP) previously known as “bronchiolitis obliterans organizing pneumonia,” is a well-documented medical condition with distinct clinicoradiological features and diagnostic criteria. COP can exhibit a diverse range of radiological presentations, including multiple patchy alveolar opacities (typical pattern), a solitary focal lesion, or diffuse bilateral infiltration. Corticosteroid therapy is typically effective in achieving rapid clinical and imaging improvement, but caution must be exercised in cases of active infections where corticosteroids are contraindicated, posing a challenge for OP diagnosis. This case series emphasizes the need for healthcare providers to be knowledgeable about the various atypical clinical manifestations of COP, recognize the diverse and uncommon radiological presentations that may mimic other pulmonary pathologies, and consider COP in the differential diagnosis to ensure appropriate management and enhance patient outcomes.

Keywords: Cryptogenic organising pneumonia; Solitary pulmonary nodule; Focal pneumonia

Introduction

Organizing Pneumonia (OP), previously known as Bronchiolitis Obliterans Organizing Pneumonia (BOOP), is a specific type of diffuse interstitial lung disease that primarily affects the small airways within the alveolar wall [1,2]. OP typically presents with characteristic radiographic features, including ground-glass opacification and/or consolidation distributed along the bronchovascular bundles. These findings tend to be more prominent in the peripheral or subpleural regions when observed on a Chest X-Ray (CXR) [2,3]. On chest Computed Tomography (CT), bilateral migratory patchy alveolar opacities are often seen, and they have a tendency to resolve spontaneously.

OP can manifest with uncommon radiographic patterns such as focal pneumonia, perilobular consolidations, curved bands of consolidation, single or multiple nodules, and a Diffuse Micronodular Pattern (DMP) [1,4,5]. Diagnosis of OP is challenging due to the nonspecific respiratory symptoms commonly observed, including cough, fever, and shortness of breath, which are also typical of infectious pneumonias. Consequently, OP is frequently misdiagnosed as an infectious etiology, leading to initial treatments involving antimicrobial agents. Ultimately, patients may undergo invasive procedures to obtain tissue samples for diagnosis. Histopathological examination of OP typically reveals the presence of granulation tissue characterized by budding fibrin exudates transitioning into collagen-containing fibroblasts and myofibroblast proliferation, interspersed with loose connective tissue within the distal air spaces [1,6]. OP has associations with various conditions, including connective tissue diseases, infections, medication side effects, acid reflux disorder, organ transplant reactions, and adjacent malignancies [1,6-8]. When no identifiable causes are found, it is referred to as Cryptogenic Organizing Pneumonia (COP).

Case Series

We present a case series of four middle-aged patients who presented with acute-onset dry cough, low-grade fever, shortness of breath, and chest pain. Upon examination, their vital signs were stable, and general and systemic assessments were unremarkable. Initial routine blood and sputum analyses provided inconclusive results. These patients were initially treated with antibiotics for suspected community-acquired pneumonia but were later referred to our center for further diagnostic workup.

The diagnostic workup encompassed a thorough evaluation to rule out other potential causes of their atypical presentations. Chest X-ray in the posterior-anterior view revealed well-defined rounded lesions in the right mid-zone for two patients and consolidation in the right lower lobe for another patient (Figure 1). Imaging studies, including High-Resolution Computed Tomography (HRCT), played a pivotal role in identifying characteristic features of Cryptogenic Organizing Pneumonia (COP) in different anatomical locations. CT-guided biopsies were performed on these lesions, confirming histopathological findings consistent with COP (Figure 1).

Citation: Ramana Prasad VV, Shah C, Kumar K. Exploring Diverse Presentations of Cryptogenic Organizing Pneumonia: A Case Series. Austin J Pulm Respir Med. 2023; 10(2): 1099.