Cryptogenic Organizing Pneumonia: A Misdiagnosis or Missed Diagnosis in Resource –Poor Settings: A Case Report and Literature Review.
Article Sidebar
Main Article Content
Abstract
Background: Cryptogenic organising pneumonia (COP) is a diagnosis made by a combination of clinical, radiological and histology features; after ruling out other causes of organizing pneumonia. There is no consensus on prevalence. COP is often missed or widely misdiagnosed and under-reported in resource-poor settings (like Nigeria); where diagnostic modalities such as Chest CT (computed tomography) scan and lung biopsy are not readily available. Most febrile patients who present with cough and have opacities or infiltrate on chest radiograph, are diagnosed as pneumonia (from infective causes) and treated with antimicrobial agent for prolonged periods, despite persistent of symptoms.
Case Presentation: A 57-year-old male who was referred to the Pulmonologist for specialist evaluation for persistence of chronic cough, dyspnoea, weight loss and other constitutional symptoms despites prolong use of antibiotics. Chest examination revealed reduced breath sounds on the both lower lung zone and crackles on left mid and both lower lung zones posteriorly. Chest radiography showed consolidation. He was given several courses of antibiotic therapy with no resolution prior to referral. Chest CT scan done was highly suggestive of Cryptogenic Organising pneumonia (COP), which was confirmed by histology of a trans-bronchial biopsy.
Result: Patient’s symptoms abated within 72 hours of steroid administration.
Conclusion: This case report demonstrates the delay in early diagnosis of COP, where confirmatory diagnostic procedures are limited. Furthermore, it shows the prolonged/inappropriate use of antibiotic in such cases without resolution.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access article distributed under the terms 
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
How to Cite
References
1. Radzikowska E, Fijolek J. Update on crytogenic organizing pneumonia. Front MedLausanne. 2023;20(10):1146782.
2. American thhoracic Society/ European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2002;165:277–304.
3. Boots RJ, McEvoy JD, Mowat P, Le Fevre I. Bronchiolitis obliterans organising pneumonia: a clinical and radiological
review. Aust N Z J Med. 1995;25:140–5.
4. Cordier JF, Loire Robert, Brune J. Idiopathic Bronchiolitis Obliterans Organizing Pneumonia: Definition of Characteristic Clinical Profile in a series of 16 Patients. Chest. 1989;96(5):999–1004.
5. Chang J, Kim DW, Lee I, Han J, Lee KY, Jung S, et al. Bronchiolitis obliterans organizing pneumonia: clinicopathologic review of a series of 45 Korean patients including rapidly progressive form. J Korean Med Sci.
2002;17:179–86.
6. Epler GR, Colby TV, McLoud TC, Carrington CB, Gaensler EA. Bronchiolitis obliterans organizing pneumonia. N Engl J Med. 1985;312:152–8.
7. Cordier JF. Cryptogenic Organising pneumonia. Clin Chest Med. 2004;25:727–38.
8. Huo J, Liu C, Jin B, Duan F, Mei S, Li X, et al. Cryptogenic organizing pneumonia masquerading as lung carcinoma: a case report and review of the review of the literature.
9. Rea G, Pignatiello M, Longobardi L, Barbieri A, Cappabianca S, Valente T. Diagnostic clues of organizing pneumonia: a case presentation. Quant Imaging Med Surg. 2017;7(1):144– 8.
10. Li X, Peng S, Wei L. Nonspecific interstitial pneumonia overlaps organizing pneumonia in lung-dominant connective tissue disease. Int J Clin Exp Pathol. 2015 Sep;8(9):11230–5.
11. Juston-Baque M, Pellegrin A, Leroy S, Marquette CH, Padovani B. Organising pneumonia: what is it? A conceptual
approach and pictoria review. Diagn Interv Imaging. 2014 Sep;95(9):771–7.
12. Poletti V, Cazzato S, Minicuci N, Zompatori M, Burzi M, Schiattone. The diagnostic value of nronchoalveolar lavage and transbronchial lung biopsy in cryptogenic organizing pneumonia. Eur Respir J. 1996;9(12):2513–6.
13. King TE Jr, Lee J. Cryptogenic organizing pneumonia. NEJM. 2022;386(11):1069–1069.
14. Shimoda M, Tanaka Y, Morimoto K, Yoshimori K, Ohta K. Spontaneous resolution of cryptogenic organising
pneumonia: observational study. Medicine(Baltimore). 2023;102(27):e34277.
15. Cordier JF. Organising pneumonia. Thorax. 2000;55:318–28.