title: Acute fibrinous and organizing pneumonia associated with influenza A/H1N1 pneumonia after lung transplantation.
abstract: BACKGROUND
  Immunocompromised patients, particularly after lung transplantation, are at high risk to develop atypical forms of pulmonary infections including influenza A/H1N1. Acute Fibrinous and Organizing Pneumonia (AFOP) is a special histological pattern in acute respiratory failure with high mortality.
  
  
  METHODS
  We describe a 66-year-old woman with double lung transplantation in August 2009 due to end stage pulmonary fibrosis. After prolonged weaning and subsequent promising course, she developed atypical pneumonia with diffuse pulmonary infiltrates in both lungs in January 2010. Infection with influenza A/H1N1 virus was verified. The patient rapidly suffered from respiratory insufficiency and died eight days after this diagnosis. The post-mortem revealed especially in the lower parts of the lungs the classical histological pattern of pure AFOP. Molecular analyses of lung tissue were positive for influenza A/H1N1.
  
  
  CONCLUSIONS
  To our knowledge we present the first case of AFOP triggered by viral infection, here proven to be influenza virus A/H1N1. Thus, also in the setting of viral infection the highly deadly differential diagnosis of AFOP must be considered.
authors.affiliation: Institute of Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, Freiburg, D-79106, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Otto
authors.forename: Daniela
authors.initials: D
authors.lastname: Huzly
authors.forename: Lars
authors.initials: L
authors.lastname: Kemna
authors.forename: Annegret
authors.initials: A
authors.lastname: Hüttel
authors.forename: Christoph
authors.initials: C
authors.lastname: Benk
authors.forename: Siegbert
authors.initials: S
authors.lastname: Rieg
authors.forename: Till
authors.initials: T
authors.lastname: Ploenes
authors.forename: Martin
authors.initials: M
authors.lastname: Werner
authors.forename: Gian
authors.initials: G
authors.lastname: Kayser
mesh_terms: D000368:Aged; D001999:Bronchoscopy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D009980:Influenza A virus / Q000302:isolation & purification; D007251:Influenza, Human / Q000150:complications* / Q000821:virology; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology; D016040:Lung Transplantation; D009894:Opportunistic Infections / Q000150:complications / Q000821:virology; D011014:Pneumonia / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D011024:Pneumonia, Viral / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D011658:Pulmonary Fibrosis / Q000473:pathology / Q000601:surgery*; D011859:Radiography