Institute of Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, Freiburg, D-79106, Germany.
BMC Pulm Med. 2013 May 19;13:30. doi: 10.1186/1471-2466-13-30.
Immunocompromised patients, particularly after lung transplantation, are at high risk to develop atypical forms of pulmonary infections including influenza A/H1N1. Acute Fibrinous and Organizing Pneumonia (AFOP) is a special histological pattern in acute respiratory failure with high mortality.
We describe a 66-year-old woman with double lung transplantation in August 2009 due to end stage pulmonary fibrosis. After prolonged weaning and subsequent promising course, she developed atypical pneumonia with diffuse pulmonary infiltrates in both lungs in January 2010. Infection with influenza A/H1N1 virus was verified. The patient rapidly suffered from respiratory insufficiency and died eight days after this diagnosis. The post-mortem revealed especially in the lower parts of the lungs the classical histological pattern of pure AFOP. Molecular analyses of lung tissue were positive for influenza A/H1N1.
To our knowledge we present the first case of AFOP triggered by viral infection, here proven to be influenza virus A/H1N1. Thus, also in the setting of viral infection the highly deadly differential diagnosis of AFOP must be considered.
免疫功能低下的患者，尤其是肺移植后，发生包括甲型流感 H1N1 在内的非典型肺部感染的风险很高。急性纤维蛋白性和机化性肺炎（AFOP）是急性呼吸衰竭的一种特殊组织学类型，死亡率高。
我们描述了一位 66 岁女性，因终末期肺纤维化于 2009 年 8 月接受双肺移植。经过长时间的撤机和随后的良好病程，她于 2010 年 1 月出现非典型肺炎，双肺弥漫性浸润。经证实感染了甲型 H1N1 流感病毒。患者迅速出现呼吸功能不全，并在诊断后 8 天死亡。尸检显示，特别是在肺部的下部，呈现出典型的单纯性 AFOP 组织学模式。肺组织的分子分析显示甲型 H1N1 流感病毒呈阳性。
据我们所知，我们首次报告了由病毒感染引起的 AFOP 病例，这里证实为甲型流感 H1N1 病毒。因此，即使在病毒感染的情况下，也必须考虑到高度致命的 AFOP 的鉴别诊断。
