Michael P. D'Alessandro, M.D.
Peer Review Status: Not reviewed
The patient was an 8 year old female with multisystem auto-immune disease and progressive chronic interstitial lung disease. She presented one year ago with fever, weakness, hepatitis and pneumonitis of unknown etiology. She had a repeatedly positive polymerase chain reaction for parvovirus. The lung disease progressed over the last year despite treatment with steroids, cyclosporine, cloxacillin, and gamma globulin. The patient also had 6 courses of Cytoxan for her autoimmune lung disease.
Clinical Physical Exam:
Positive polymerase chain reaction for parvovirus
Clinical Differential Diagnosis:
Bronchiolitis obliterans with organizing pneumonia
Chest film and chest CT exam showed bilateral lower lobe disease.
Images 2 and 3
Imaging Differential Diagnosis:
None was given
An open lung biopsy was performed.
The open lung biopsy showed patchy interstitial pneumonitis with organizing intra-alveolar granulation and fibrin (organizing alveolitis), and necrotizing bronchiolitis with organization and early obliteration.
Bronchiolitis Obliterans with Organizing Pneumonia
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.
Case 62, Case 63
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