Bronquiolitis obliterante con neumonía organizativa asociada a Legionella pneumophila

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Abstract

La bronquiolitis obliterante con neumonía organizativa (BONO) es una entidad infrecuente. La sintomatología clínica y las exploraciones de imagen sugieren el diagnóstico, pero es necesaria la confirmación anatomopatológica. Aunque la mayoría de los casos son idiopáticos se ha asociado a diversos procesos, fundamentalmente enfermedades del colágeno, hematológicas e infecciosas. La BONO secundaria a una infección por Legionella pneumophila es excepcional.

Translated abstract

Bronchilitis obliterans organizing pneumonia (BOOP) is an unusual pulmonary condition. The clinical features and the radiologic findings are useful for the diagnosis of BOOP. However it is necessary to confirm its presence by an open or transbronchial pulmonary biopsy specimen. BOOP is usually idiopathic, although it may also occur in association with connective tissue disease, some haemathologic disorders and in response to viral infections. The association of Legionella pneumophila infection with BOOP is very rare.

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Bronchiolitis obliterans organizing pneumonia.

T McLoud, G Epler, E A Gaensler … (1985)

In 50 of 94 patients with bronchiolitis obliterans we found no apparent cause or associated disease, and the bronchiolitis obliterans occurred with patchy organizing pneumonia. Histologic characteristics included polypoid masses of granulation tissue in lumens of small airways, alveolar ducts, and some alveoli. The fibrosis was uniform in age, suggesting that all repair had begun at the same time. The distribution was patchy, with preservation of background architecture. Clinically, there was cough or flu-like illness for 4 to 10 weeks, and crackles were heard in the lungs of 68 per cent of the patients. Radiographs showed an unusual pattern of patchy densities with a "ground glass" appearance in 81 per cent. Physiologically, there was restriction in 72 per cent of the patients, and 86 per cent had impaired diffusing capacity. Obstruction was limited to smokers. The mean follow-up period was four years. With corticosteroids, there was complete clinical and physiologic recovery in 65 per cent of the subjects; two died from progressive disease. This disorder differs from bronchiolitis obliterans with irreversible obstruction. It was confused most often with idiopathic pulmonary fibrosis. In view of the benign course and therapeutic response, a histologic distinction is important.

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Cryptogenic organizing pneumonia: CT findings in 43 patients.

Minke H. T. Hartman, Sae Byul Lee, Barbara C. N. Müller … (1994)

Description of the CT findings of cryptogenic organizing pneumonia has been limited to a small number of cases. This study was performed to characterize the CT findings of this disease in a larger number of cases and to compare the findings in immunocompetent and immunocompromised patients. The CT scans of 43 (32 immunocompetent and 11 immunocompromised) patients who had biopsy-proved cryptogenic organizing pneumonia were reviewed. The scans were obtained by using contiguous 8- or 10-mm collimation and selected thin (1.5 or 2.0 mm) section (n = 23), thin-section collimation at 10-mm intervals (n = 12), or 8- or 10-mm collimation only (n = 8). The scans were analyzed by three observers, and final decisions were reached by consensus. The most common pattern seen was consolidation, which was present alone or as part of a mixed pattern in 34 cases (79%). The consolidation had a predominantly subpleural and/or peribronchovascular distribution in 27 cases (63%). Ground-glass attenuation and nodules were seen in 26 patients (60%) and 13 patients (30%), respectively, and were usually random in distribution. Consolidation was present in 91% (29/32) of immunocompetent and 45% (5/11) of immunocompromised patients (p .25). Nodules were present in seven (22%) of 32 immunocompetent patients and six (55%) of 11 immunocompromised patients (p < .025). We conclude that in immunocompetent patients the CT findings in cryptogenic organizing pneumonia most commonly consist of bilateral areas of consolidation involving mainly the subpleural and/or peribronchovascular regions. In the immunocompromised patient, the CT findings are variable.