Deutsche medizinische Wochenschrift (1946) · 1996
[Bronchiolitis obliterans with organizing pneumonia: differential diagnosis of pneumonia refractory to antibiotics].
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Thomas M, Diederich S, Roos N, Kiehl M, van de Loo J
Аннотация
HISTORY AND FINDINGS: A previously healthy 58-year-old woman was admitted with rapidly worsening dyspnoea, dry cough and subfebrile temperature. Chest radiogram showed spotty infiltrations, especially in the bases of both lungs. She was dyspnoic with mild tachypnoea (24/min) and mild cyanosis of the lips. Fine, non-resonant rales were heard over the middle and lower lobes bilaterally.
INVESTIGATIONS: Erythrocyte sedimentation rate was markedly raised (97/110 mm), arterial oxygen partial pressure slightly decreased (45 mm Hg), CO2 partial pressure was 32 mm Hg. Bronchoalveolar lavage was unremarkable.
TREATMENT AND COURSE: Because of the respiratory impairment broad antibiotic treatment was at once commenced empirically with gentamycin, cefotaxim, erythromycin, rifampicin and fluconazole. As the response was poor, a transbronchial lung biopsy was performed. This merely showed nonspecific lymphoplasmacellular bronchitis. An open biopsy then revealed bronchiolitis obliterans with organizing pneumonia (BOOP). Treatment with initially 75 mg prednisone daily quickly brought about improvement and the patient was entirely well after 6 months.
CONCLUSION: The described constellation of history and clinical as well as radiological findings should strongly suggest BOOP. With adequate treatment the prognosis is excellent.
INVESTIGATIONS: Erythrocyte sedimentation rate was markedly raised (97/110 mm), arterial oxygen partial pressure slightly decreased (45 mm Hg), CO2 partial pressure was 32 mm Hg. Bronchoalveolar lavage was unremarkable.
TREATMENT AND COURSE: Because of the respiratory impairment broad antibiotic treatment was at once commenced empirically with gentamycin, cefotaxim, erythromycin, rifampicin and fluconazole. As the response was poor, a transbronchial lung biopsy was performed. This merely showed nonspecific lymphoplasmacellular bronchitis. An open biopsy then revealed bronchiolitis obliterans with organizing pneumonia (BOOP). Treatment with initially 75 mg prednisone daily quickly brought about improvement and the patient was entirely well after 6 months.
CONCLUSION: The described constellation of history and clinical as well as radiological findings should strongly suggest BOOP. With adequate treatment the prognosis is excellent.