[Bronchiolitis obliterans with organizing pneumonia: differential diagnosis of pneumonia refractory to antibiotics].
METHODS
A previously healthy 58-year-old woman was admitted with rapidly worsening dyspnoea, dry cough and subfebrile temperature. Chest radiogram showed spotty infiltrations, especially in the bases of both lungs. She was dyspnoic with mild tachypnoea (24/min) and mild cyanosis of the lips. Fine, non-resonant rales were heard over the middle and lower lobes bilaterally.


METHODS
Erythrocyte sedimentation rate was markedly raised (97/110 mm), arterial oxygen partial pressure slightly decreased (45 mm Hg), CO2 partial pressure was 32 mm Hg. Bronchoalveolar lavage was unremarkable.


METHODS
Because of the respiratory impairment broad antibiotic treatment was at once commenced empirically with gentamycin, cefotaxim, erythromycin, rifampicin and fluconazole. As the response was poor, a transbronchial lung biopsy was performed. This merely showed nonspecific lymphoplasmacellular bronchitis. An open biopsy then revealed bronchiolitis obliterans with organizing pneumonia (BOOP). Treatment with initially 75 mg prednisone daily quickly brought about improvement and the patient was entirely well after 6 months.


CONCLUSIONS
The described constellation of history and clinical as well as radiological findings should strongly suggest BOOP. With adequate treatment the prognosis is excellent.
Thomas
M
M
Sowie Institut für Klinische Radiologie, Medizinische Klinik und Poliklinik A, der Universität Münster.
Diederich
S
S
Roos
N
N
Kiehl
M
M
van de Loo
J
J
D000900:Anti-Bacterial Agents; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D002245:Carbon Dioxide / Q000097:blood; D018549:Cryptogenic Organizing Pneumonia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011241:Prednisone / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D002245:Carbon Dioxide; D010100:Oxygen; D011241:Prednisone
Bronchiolitis obliterans mit organisierender Pneumonie. Differentialdiagnose der antibiotikarefraktären Pneumonien.