Clinical features of acute fibrinous and organizing pneumonia: An early histologic pattern of various acute inflammatory lung diseases
Fig 4
Representative clinicoradiological courses of four patients in the AFOP group.
(A1-3) Patient 1. Chest CT images in a 63-year-old man with COP. (A1) Consolidation and GGO with air bronchogram in the right upper lobe at diagnosis. (A2) Three months after the administration of corticosteroids, relapse was observed in the left upper lobe. (A3) One year after the diagnosis, most of the shadow had improved, but the patient continued to experience relapses. (B1-3) Patient 2. A 65-year-old man with advanced lung cancer treated with anti-PD-1 antibody. (B1) Drug-induced pneumonia with consolidation and GGO in the left upper lobe that had developed four months after the initiation of the anti-PD-1 antibody therapy. (B2) Three weeks after corticosteroid treatment. (B3) One year after the diagnosis of drug-induced pneumonia, relapse was observed in both lower lobes. (C1-3) Patient 3. A 67-year-old woman after radiation therapy for right breast cancer. (C1) Radiation pneumonitis with halo sign developed six months after the radiation therapy. (C2) Three months after the treatment with corticosteroids. (C3) Six months after the diagnosis of radiation pneumonitis, relapse of radiation pneumonitis was observed. The therapeutic course was good with increased corticosteroid dosage. (D1-3) Patient 4. A 74-year-old man with anti-MDA5 antibody-positive dermatomyositis and rapidly progressive interstitial lung disease. (D1) Consolidation and GGO along the peripheral bronchovascular bundle predominantly in the lower lobes at the initial visit. (D2) At the time of admission, the shadow had progressed further within a week. (D3) Despite intense treatment with biweekly intravenous cyclophosphamide pulse (1000 mg/day), tacrolimus (5 mg/day), plasma exchange, and methylprednisolone pulses (1000 mg/day) followed by oral corticosteroid (1 mg/kg/day), extensive infiltrative shadow and pneumomediastinum had developed. The patient died due to acute respiratory failure four weeks after the initial visit.