title: Cryptogenic organizing pneumonia associated with invasive pulmonary aspergillosis: a case report and review of the literature.
abstract: BACKGROUND
  Concomitant occurrence of invasive pulmonary aspergillosis (IPA) with cryptogenic organizing pneumonia (COP) is scarce. Here, we report a case where COP was a presenting feature in a patient with diagnosed IPA, and review additional 58 COP patients reported in the literature from 1988 through 2013.
  
  
  METHODS
  The study was reviewed and approved by the Institutional Ethics Committee of Shanghai Tenth People's Hospital of Tongji University and was conducted in compliance with the Helsinki Declaration. Written informed consent was obtained from patient. A 56-year-old man presenting with productive cough for several weeks and unremitting high fever for a week was hospitalized with an initial clinical diagnosis of pneumonia, for which antibiotics were prescribed but did not work. Seeing that the condition progressed both clinically and radiographically, bronchoscopy, bronchoalveolar lavage and lung biopsy were performed, and the diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-existence was made. Initially, the patient responded to steroid pulse therapy and voriconazole treatment, and his condition was partially improved. However, the patient's condition deteriorated progressively 5 months after the disease onset and the patient died during the third admission due to respiratory failure and the adverse reactions of coriaceous hormone therapy.
  
  
  CONCLUSIONS
  The diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-occurrence depends on clinical, radiological and histological presentations. Similarities with other disease processes could lead to a delayed diagnosis or misdiagnosis. The present case suggests that clinicians should be alert to this disease in their clinical practices.
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Tongji University, Shanghai 200072, PR China.
authors: Shuanshuan
authors: S
authors: Xie
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Tongji University, Shanghai 200072, PR China.
authors: Changxing
authors: C
authors: Shen
authors: Department of Respiratory Medicine, Shanghai Liqun Hospital Putuo District, Shanghai 200072, PR China.
authors: Yunfeng
authors: Y
authors: Zhang
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Tongji University, Shanghai 200072, PR China.
authors: Kun
authors: K
authors: Lu
authors: Department of Respiratory Medicine, Shanghai St.Lukes Hospital Shanghai 200072, PR China.
authors: Feng
authors: F
authors: Hu
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Tongji University, Shanghai 200072, PR China.
authors: Min
authors: M
authors: Tan
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Tongji University, Shanghai 200072, PR China.
authors: Haiyan
authors: H
authors: Lin
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Tongji University, Shanghai 200072, PR China.
authors: Lei
authors: L
authors: Xu
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Tongji University, Shanghai 200072, PR China.
authors: Qing
authors: Q
authors: Yuan
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Tongji University, Shanghai 200072, PR China.
authors: Xiaolian
authors: X
authors: Song
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital Tongji University, Shanghai 200072, PR China.
authors: Changhui
authors: C
authors: Wang
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D018549:Cryptogenic Organizing Pneumonia / Q000150:complications* / Q000188:drug therapy / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D065819:Voriconazole
keywords: Cryptogenic organizing pneumonia; bronchiolitis obliterans organizing pneumonia; invasive pulmonary aspergillosis