Acute fibrinous and organizing pneumonia with myelodysplastic syndrome and pneumocystis jiroveci pneumonia: a case report
Acute fibrinous and organizing pneumonia with myelodysplastic syndrome and pneumocystis jiroveci pneumonia: a case report
复制标题
DOI：
10.21037/apm-20-2344
复制
发表时间：
2021-07-01
影响因子：
--
通讯作者：
Qiu, Yuying
中科院分区：
文献类型：
--
作者：
Lin, Minjie;Zhang, Yingwei;Qiu, Yuying
急性肺泡炎和机化性肺炎（acute acute acupuncture and organizing pneumonia，AFOP）是一种以肺泡内纤维蛋白沉积（纤维蛋白球）和散在分布的机化性肺炎为特征的少见病理类型，病理诊断在诊断中具有不可替代的作用。大多数患者无法确定病因，目前已知病因包括结缔组织病、感染、环境和职业暴露、药物、器官移植和肿瘤。根据进展程度可分为急性和亚急性亚型。AFOP最常见的症状是发热、咳嗽和呼吸困难。双侧实变和磨玻璃样阴影（GGO）通常可以在胸部CT图像上看到。目前，AFOP的治疗方案尚未达成共识，糖皮质激素、免疫抑制剂、干细胞移植或肺移植可能有助于改善临床结局。在这里，我们报告一个AFOP的情况下，骨髓增生异常综合征和肺囊虫肺炎（PJP）。经糖皮质激素、免疫抑制剂、化疗、抗生素及输血等治疗后，患者临床症状、外周血及影像学检查均明显改善。本病例认为AFOP是由骨髓增生异常综合征引起，化疗后免疫缺陷导致继发性PJP。这一典型病例强调了对难治性AFOP患者的并存疾病进行适当治疗的重要性。
Acute fibrinous and organizing pneumonia (AFOP) is an unusual pathological pattern which is characterized by intra-alveolar deposition of fibrin (fibrin ball) and organizing pneumonia in a scattered distribution, and the pathological diagnosis plays an irreplaceable role in the diagnosis. Most Patients cannot confirm etiology, till now, known etiology included connective tissue disease, infection, environmental and occupational exposure, drugs, organ transplant, and tumor. It can be divided into acute and subacute subtype according to the extent of progress. The most common symptoms of AFOP were fever, cough, and dyspnea. Bilateral consolidations and ground-glass opacities (GGO) usually can be seen on chest CT images. At present, the treatment protocol for AFOP has not reached a consensus Glucocorticoid, immunosuppressants, stem cell transplantation or lung transplantation may contribute to improved clinical outcome. Here, we report a case of AFOP with myelodysplastic syndrome and pneumocystis jiroveci pneumonia (PJP). After treatments of glucocorticoid, immunosuppressant, chemotherapy, antibiotics and blood transfusion, the patient's clinical symptoms, peripheral blood test, and imaging findings were obviously improved. In this case, we consider the AFOP was caused by MDS and the immunodeficiency after chemotherapy lead to secondary PJP. This typical case highlights the importance of appropriate therapy for coexisted diseases of those patients with refractory AFOP.