Case 11

Michael P. D'Alessandro, M.D.
Peer Review Status: Not reviewed

Clinical History:
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:
Respiratory distress.

Clinical Labs:
Positive polymerase chain reaction for parvovirus

Clinical Differential Diagnosis:
Bronchiolitis obliterans with organizing pneumonia

Imaging Findings:
Chest film and chest CT exam showed bilateral lower lobe disease.

Image 1

Images 2 and 3

Imaging Differential Diagnosis:
None was given

Operative Findings:
An open lung biopsy was performed.

Pathological Findings:
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.

Final Diagnosis:
Bronchiolitis Obliterans with Organizing Pneumonia

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 62, Case 63

References:

• International Thoracic Teaching Resource - http://www.vh.org/adult/provider/radiology/ITTR/BOOP/BOOP.html

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