Updated: 3/28/2019

Cryptogenic Organizing Pneumonia

0%
Topic
Review Topic
0
0
Snapshot
  • A 56-year-old man presents for a follow up with his primary care physician for a few weeks of low-grade fevers, cough, malaise, and shortness of breath. He had tested negative for tuberculosis and his sputum cultures had shown no growth. His symptoms have not responded to a course of azithromycin. His past medical history includes hypertension, for which he is taking hydrochlorothiazide. He has no history of autoimmune diseases. He currently works as a software engineer. On physical exam, there are sparse inspiratory crackles bilaterally. A chest radiograph shows bilateral patchy infiltrates, and he is sent for a high-resolution computed tomography.
Introduction
  • Clinical definition
    • cryptogenic organizing pneumonia (COP) is a rare organizing noninfectious pneumonia/bronchiolitis in which the cause is often unknown
      • may be caused by chronic inflammatory diseases or medications
    • previously known as bronchiolitis obliterans organizing pneumonia (BOOP)
  • Epidemiology
    • incidence
      • rare
    • demographics
      • adults
    • risk factors
      • chronic inflammatory diseases
        • rheumatoid arthritis
        • other connective tissue diseases
      • medications
        • amiodarone
  • Pathogenesis
    • inflammation of the small airways (bronchioles) with chronic alveolitis
    • exact pathogenesis is unknown but thought to be related to alveolar injury and fibrotic alveolar bud formation
  • Prognosis
    • typically very good with treatment
Presentation
  • Symptoms
    • systemic symptoms
      • fever
      • malaise
      • myalgia
    • cough
    • shortness of breath
  • Physical exam
    • respiratory
      • rales
      • inspiratory crackles
Imaging
  • Chest radiography
    • findings
      • bilateral patchy infiltrates
  • Chest computed tomography (CT)
    • findings
      • patchy and migratory ground-glass opacities
      • alveolitis
Studies
  • Sputum and blood cultures
    • negative
  • Transbronchial biopsy or video-assisted thoracoscopy
    • histology
      • endoluminal buds of granulation tissue and connective tissue
      • Masson body that plugs the small airways
      • obliterated airways
  • Making the diagnosis
    • based on clinical presentation and studies
    • definitive diagnosis via biopsy results
Differential
  • Pneumoconioses (e.g., asbestosis)
    • distinguishing factor
      • typically does not present with systemic symptoms
      • presents with a more chronic course
      • typically has a clear occupational exposure
      • does not respond to steroids
Treatment
  • Management approach
    • COP does not respond to antibiotics
  • First-line
    • steroids
Complications
  • Relapse of disease
  • Respiratory failure
    • rare
 

Please rate topic.

Average 5.0 of 2 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (0)
Private Note