Ye Bing, Chen Chun, Huang Lin, Chen Jingyu, Weng Qinyong, Wu Weidong
Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
AME Case Rep. 2023 Sep 21;7:44. doi: 10.21037/acr-22-88. eCollection 2023.
Acute fibrinous and organizing pneumonia (AFOP) is one of acute expiratory diseases, which occurs rarely with a difficult diagnosis. AFOP is related to an idiopathic cause or autoimmune disease, drug use, infection, cancer, or transplantation. Variation of treatment depends on different institutions. To date, no evidence shows that lobar lung transplantation is applied in an urgent situation such as AFOP.
A 33-year-old female patient experienced fever, cough, and dyspnea four days prior to admission. She had no underlying health conditions. Initially, she received oxygen therapy and empiric antimicrobial treatment, but later developed pulmonary consolidation. Pathological examination confirmed the diagnosis of AFOP. Despite receiving standardized treatment involving extracorporeal membrane oxygenation (ECMO) and mechanical ventilation, the patient's respiratory function remained compromised. Consequently, an urgent lobar lung transplantation was performed. However, the patient encountered several challenges including carbapenem-resistant pneumonia, exophytic granulation tissue, anastomotic stenosis, bronchopleural fistulae, anastomotic infections, septic shock, bacteremia, reperfusion syndrome, primary graft dysfunction, severe renal failure, and critical illness myopathy. Although the patient ultimately recovered and had a favorable survival outcome over 1-year post-discharge through multidisciplinary care, there are several key points to consider. Based on the findings from a systematic review, urgent transplantation may be a potential alternative treatment for AFOP. However, peri-transplantation programs should be enhanced, particularly regarding criteria selection, ECMO management, and the role of enhanced recovery after transplantation.
The case demonstrates the feasibility of bilateral lobar lung transplantation in patients with AFOP, especially in an urgent situation.
急性纤维蛋白性及机化性肺炎（AFOP）是一种急性呼气性疾病，发病率低且诊断困难。AFOP与特发性病因、自身免疫性疾病、药物使用、感染、癌症或移植有关。不同机构的治疗方法存在差异。迄今为止，尚无证据表明叶状肺移植适用于AFOP等紧急情况。
一名33岁女性患者入院前四天出现发热、咳嗽和呼吸困难。她没有基础健康问题。最初，她接受了氧疗和经验性抗菌治疗，但后来出现了肺部实变。病理检查确诊为AFOP。尽管接受了包括体外膜肺氧合（ECMO）和机械通气在内的标准化治疗，但患者的呼吸功能仍受损。因此，进行了紧急叶状肺移植。然而，患者面临着多重挑战，包括耐碳青霉烯类肺炎、外生性肉芽组织、吻合口狭窄、支气管胸膜瘘、吻合口感染、感染性休克、菌血症、再灌注综合征、原发性移植物功能障碍、严重肾衰竭和危重病性肌病。尽管患者最终康复，出院后通过多学科护理在1年多的时间里获得了良好的生存结果，但仍有几个关键点需要考虑。基于系统评价的结果，紧急移植可能是AFOP的一种潜在替代治疗方法。然而，围移植期方案应予以加强，特别是在标准选择、ECMO管理以及移植后加速康复的作用方面。
该病例证明了双侧叶状肺移植在AFOP患者中的可行性，尤其是在紧急情况下。
