title: Acute fibrinous and organizing pneumonia masquerading as a lower respiratory tract infection: a case report and review of the literature.
abstract: BACKGROUND
  Acute Fibrinous and Organizing Pneumonia is a rare entity characterized by the histological pattern suggestive of diffuse alveolar damage, eosinophilic pneumonia and organizing pneumonia; the presence of intra alveolar "fibrin balls" distinguishes it from these conditions. Herein, we describe the association of acute fibrinous and organizing pneumonia with a respiratory tract infection. We believe that such an association has been extremely rarely described.
  
  
  METHODS
  We report the case of a 68 year old female patient of Afghan descent who presented with shortness of breath, cough and high grade fever not responding satisfactorily to standard antibiotic therapy. Imaging revealed bilateral basilar infiltrates and ground glass opacification of the right lower lung zone. Though the inflammatory markers decreased with antibiotic therapy, there was minimal improvement in the patient's symptoms and radiological appearance of the lungs. Bronchoscopy was refused by the patient's family and a Computed Tomography guided biopsy of the lung revealed a histological diagnosis of acute fibrinous and organizing pneumonia. Patient was initiated on high dose intravenous corticosteroid therapy followed by a maintenance dose of prednisolone at 40 mg/day. She recovered dramatically. However, due to poor compliance with treatment, she relapsed and was re-treated with the same regimen. Currently she is completely symptom free and is on a tapering corticosteroid dose.
  
  
  CONCLUSIONS
  We conclude that AFOP may be a rare but under diagnosed entity and recommend that it should be considered in the differentials of a suspected pulmonary infection unresponsive to optimum antibiotic therapy.
authors.affiliation: Department of Pulmonology and Critical Care, Shifa International Hospital, Islamabad, Pakistan. saadayeshaaftab@gmail.com.
authors.forename: Aftab
authors.initials: A
authors.lastname: Akhtar
authors.affiliation: Resident Internal Medicine, Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan. zain.u.abideens@gmail.com.
authors.forename: Zain
authors.initials: Z
authors.lastname: Ul Abideen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D011014:Pneumonia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use*; D011658:Pulmonary Fibrosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D011859:Radiography; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D011239:Prednisolone