Li Zhengtu, Xu Beini, Liu Jie
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
Respir Med Case Rep. 2024 Sep 29;52:102120. doi: 10.1016/j.rmcr.2024.102120. eCollection 2024.
Acute fibrinous and organizing pneumonia (AFOP) is a rare form of pneumonia, is characterized by the deposition of fibrin in alveoli, the formation of fibrin spheres, and deposition of fibrin in alveolar junctions and bronchioles adjacent to or adjacent to the alveoli, forming institutional loose connective tissue.The clinical characteristics of AFOP lack specificity. We report a special case of AFOP that may be associated with , so as to improve our understanding and diagnosis of AFOP.
In this patient who was early misdiagnosed with community-acquired pneumonia (CAP), the empirical anti-infective treatment was ineffective, and various infectious and non-infectious factors were excluded. Flexible bronchoscopy was subsequently performed, and metagenomics Next Generation Sequencing (mNGS) of Bronchoalveolar lavage fluid (BALF) showed , and further ultrasound interventional percutaneous and lung puncture biopsy was performed to diagnose AFOP according to pathology, while mNGS of lung pathological tissue also suggested . The patient recovered well on corticosteroids.
The clinical manifestation, laboratory examination and imaging examination of AFOP has no specificity, lung biopsy and pathological examination should be carried out to make a clear diagnosis by comprehensively considering the clinical manifestations, auxiliary examination, pathology and other aspects of the patients. After definite diagnosis, it is still necessary to rule out various diseases and environmental exposure and further classify them as idiopathic or secondary, so as to choose monotherapy or combination therapy.
急性纤维蛋白性及机化性肺炎（AFOP）是一种罕见的肺炎形式，其特征为纤维蛋白在肺泡内沉积、形成纤维蛋白球，以及在肺泡连接处和与肺泡相邻或紧邻的细支气管中沉积纤维蛋白，形成机化性疏松结缔组织。AFOP的临床特征缺乏特异性。我们报告一例可能与之相关的AFOP特殊病例，以提高我们对AFOP的认识和诊断。
该患者早期被误诊为社区获得性肺炎（CAP），经验性抗感染治疗无效，且排除了各种感染性和非感染性因素。随后进行了可弯曲支气管镜检查，支气管肺泡灌洗液（BALF）的宏基因组下一代测序（mNGS）显示 ，并进一步进行了超声引导下经皮肺穿刺活检以根据病理诊断AFOP，同时肺病理组织的mNGS也提示 。该患者使用糖皮质激素后恢复良好。
AFOP的临床表现、实验室检查及影像学检查均无特异性，应进行肺活检及病理检查，综合考虑患者的临床表现、辅助检查、病理等方面以明确诊断。明确诊断后，仍需排除各种疾病及环境暴露因素，并进一步将其分类为特发性或继发性，从而选择单一疗法或联合疗法。
