Name
BRONCHIOLITIS OBLITERANS & ORGANIZING PNEUMONIA
DESCRIPTION
DETAIL
CAUSES: Idiopathic. A complex response to a variety of injuries, such as toxic inhalation; post mycoplasma, viral and bacterial infection; aspiration; immunologic factors. -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Usual interstitial pneumonitis (UIP) β’ Noninfectious diseases β’ Tuberculosis β’ Sarcoidosis β’ Histoplasmosis β’ Berylliosis β’ Goodpasture syndrome β’ Neoplasm β’ Polyarteritis nodosa β’ Systemic lupus erythematosus β’ Wegener granulomatosis β’ SjΓΆgren syndrome β’ Chronic eosinophilic pneumonia β’ Cryptogenic bronchiolitisβ’ Leukocytosis with a normal differential β’ Elevated ESR, usually quite elevated β’ Negative cultures β’ Negative serology for mycoplasma, Coxiella, Legionella, psittacosis, And fungus β’ Negative viral studies SPECIAL TESTS: β’ Pulmonary function shows a restrictive/obstructive pattern β’ Flow-volume loop shows terminal airway obstruction β’ Chest x-ray may show patchy alveolar opacities often in the mid or upper lung area. A ground glass pattern that may have air bronchograms. β’ V/Q scan: matched patchy defects IMAGING: β’ Chest x-ray - often appears more normal than the physical examination β’ CT scans more accurately define the distribution and extent of the patchy alveolar opacities with areas of hyperlucency DIAGNOSTIC PROCEDURES: β’ Open lung biopsy β’ Transbronchial biopsy β’ It may be well to use a trial of steroids as a diagnostic trial, though not all would agree β’ If a diagnostic trial is successful, be prepared to treat the patient for at least a year
TYPENOTES
RISK FACTORS: AIDS, Immunocompromised patients, including transplant patientsGENERAL MEASURES: β’ Monitor blood gases or pulse oximetry β’ Oxygen as necessary DRUG(S) OF CHOICE: . Prednisone : 60 mg daily for 1-3 months. Then tapered over a few weeks to 20 mg (this dose may later be given as alternate day therapy). Increase length of taper for patients on long-term therapy to avoid precipitating Addisonian crisis. Treatment may be needed for one year or more PATIENT MONITORING: β’ Frequent visits, weekly initially β’ Emphasize the need to continue the prednisone because of the chance of relapse β’ Monitor the lung disease and the side effects of prednisone therapy (Mantoux, monthly CBC, funduscopic exam every 3-6 months) POSSIBLE COMPLICATIONS: β’ Bronchiectasis β’ Death, but with proper treatment, recovery is usually complete without permanent sequelae EXPECTED COURSE/PROGNOSIS: Complete recovery but individual case management is mandatory AGE-RELATED FACTORS: Pediatric: Rare, but has been reported after viral pneumonia (adenovirus infl uenza). Characteristics include delayed recovery, persistent cough, crackles or wheezing after pneumonia. The laboratory fi ndings are generally not helpful. Imaging shows: V/Qm matched defects; HRCT, bronchiectasis, bronchogram, pruned tree appearance. Diagnosis confi rmed by biopsy. Treatment includes steroids - 1 mg/kg/24 hrs for one month, followed by weaning over several months.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY CHEST P.A. VIEW( NORMAL ), COMPLETE BLOOD COUNT, PULMONARY FUNCTION TEST, SPUTUM FOR GRAM STAINING, SPUTUM FOR CULTURE & SENSTIVITY TEST, BIOPSY