Lessons to be learned: a case study approach. Bronchiolitis obliterans organising pneumonia: a reversible cause of respiratory failure.

A 70-year-old lady was admitted to hospital through the casualty department with suspected bilateral community acquired pneumonia. Although she received intravenous antibiotics, high concentrations of supplemental inhaled oxygen and continuous positive airway pressure therapy there was failure to respond. Abnormal levels of peripheral blood neutrophil and eosinophil counts as well as computerised tomography chest scan appearances suggested bronchiolitis obliterans organising pneumonia. The diagnosis was confirmed by a lung biopsy obtained by video-assisted thoracoscopy under general anaesthesia. She made a prompt and complete recovery with oral steroid treatment.