Lee Young Joo, Kim Young Sun
Department of Obstetrics and Gynecology, Kyung Hee University Medical Center, Seoul 02447, South Korea.
World J Clin Cases. 2022 Feb 26;10(6):1946-1951. doi: 10.12998/wjcc.v10.i6.1946.
Cryptogenic organizing pneumonia (COP), formerly known as bronchiolitis obliterans organizing pneumonia, is an extremely rare disease in pregnancy. In this case, we report on COP diagnosed in recurrent pneumonia that does not respond to antibiotics in pregnant woman.
A 35-year-old woman with no prior lung disease presented with concerns of chest pain with cough, sputum, dyspnea, and mild fever at 11 wk' gestation. She was diagnosed with community-acquired pneumonia and treated with antibiotics; her symptoms improved temporarily. Four weeks after discharge, she was re-admitted with aggravated symptoms. Chest computed tomography demonstrated multifocal patchy airspace consolidation and ground-glass opacities at the basal segments of the right lower lobe, at the lateral basal segment of the lower lobe, and at the lingular segment of the left upper lobe. Bronchoalveolar lavage revealed an increased lymphocyte count and a decreased CD4/CD8 ratio. Prednisolone (0.5 mg/kg/d) was administered for 10 d after the second admission. Dyspnea improved after 3 d of steroid treatment and other symptoms improved on the 5 day of steroid administration. Post-delivery transbronchial lung biopsy further revealed the presence of granulation tissue with fibroblasts in small-bronchiole lumens.
This case suggests that it is important to differentiate COP from atypical pneumonia in the deteriorated condition despite antibiotic treatment.
隐源性机化性肺炎（COP），既往称为闭塞性细支气管炎机化性肺炎，是一种在妊娠期极为罕见的疾病。在此病例中，我们报告了一名孕妇反复发生肺炎且对抗生素治疗无反应，最终诊断为COP的病例。
一名35岁无既往肺部疾病史的女性，在妊娠11周时出现胸痛伴咳嗽、咳痰、呼吸困难及低热。她被诊断为社区获得性肺炎并接受抗生素治疗，症状暂时改善。出院四周后，她因症状加重再次入院。胸部计算机断层扫描显示右下叶基底段、下叶外侧基底段及左上叶舌段多发斑片状实变影及磨玻璃影。支气管肺泡灌洗显示淋巴细胞计数增加，CD4/CD8比值降低。第二次入院后给予泼尼松龙（0.5mg/kg/d）治疗10天。激素治疗3天后呼吸困难改善，激素治疗第5天其他症状改善。产后经支气管肺活检进一步显示小支气管腔内存在伴有成纤维细胞的肉芽组织。
该病例提示，在病情恶化时，即使经过抗生素治疗，将COP与非典型肺炎相鉴别也很重要。
