Successful steroid treatment for acute fibrinous and organizing pneumonia: A case report

Ning, Ya-Jing; Ding, Pei-Shan; Ke, Zhang-Yan; Zhang, Yan-Bei; Liu, Rong-Yu

Although the histopathological features are well described, the clinical manifestations, course, and treatment of AFOP are not characterized. Because the clinical manifestations are nonspecific, the pathogenesis of AFOP is not fully understood. It can be idiopathic or associated with a wide spectrum of clinical conditions, such as connective tissue diseases [4, 6, 7] , bacterial infec tions or viral infections [3, 8] , specific etiologic agent like Chlamydophila pneumoniae [9] , chronic renal insu fficiency [10] , drug reaction or druginduced toxicity [11] , hematologic disease [12, 13] , hematopoietic stem cell transplantation [14] , and occupational or environmental exposures [1] . There is still no standard treatment for AFOP. Therapy with steroids alone or combined with immu nosuppressants was attempted, but the dosage and duration of steroid treatment are still unclear. Usually 0.51 mg/kg daily of prednisone (or equivalent) are prescribed initially. A maximal dose of methy lprednisolone was reported to be up to 1000 mg/d [4] . A pulse therapy of steroids was also administered in some fulminant patients [7, 10, 15, 16] . Besides steroids, immunosuppressive agents such as cyclophosphamide, mycophenolate mofetil, cyclosporine and azathioprine have been tried in AFOP patients complicated with connective tissue diseases [4, 6, 7, 17] . In addition, Zhou et al [18] reported that lowdose indomethacin combined with methylprednisolone was a new choice of treatment.