Acute fibrinous and organizing pneumonia: Case report and literature review

Marouane Menchi-Elanzi*, Raquel García-Sevila**, María-del-Mar García-Rodenas**, Estela Costa-Navarro***, José-Manuel Ramos-Rincón*,#, Concepción Martin-Serrano**

* Internal Medicine Service, General University Hospital of Alicante, Alicante, Spain - **Pneumology Service, General University Hospital of Alicante, Alicante, Spain - ***Pathological Anatomy Service, General University Hospital of Alicante, Alicante, Spain

Introduction: Acute fibrinous and organizing pneumonia (AFOP) is a rare histological patterns of interstitial pneumonia. In most cases, it is considered idiopathic, although it has been associated with infections, autoimmune diseases, drugs, environmental and occupational exposures, cancers, and solid organ transplants. 

Material and methods: We report a case of a 45-year-old man presenting with respiratory distress and fever who was finally diagnosed with AFOP with good clinical evolution with steroids; and no history of exposure to environmental toxins, animals, or recent travel. We also review the available literature in the PubMed database between 1962 and May 31th 2018 

Results: We identified 43 articles which reported in 94 cases. Patients’ mean age was 52.3 years (range 14 to 73), and the majority (54.2%) were men. Idiopathic etiology was the most frequent cause of the disease (48% of cases), followed by autoimmune diseases (12.7%), pharmacological treatments were the cause of 10.6% of the cases. Most cases (90.4%) were treated with corticosteroids. A quarter of the patients had an unfavorable evolution and died.

Conclusion: The literature shows that suspicion of AFOP is warranted in young patients with pneumonia that do not respond to antibiotic treatment. AFOP is probably an underdiagnosed entity, as a pulmonary biopsy is necessary to reach a diagnosis.