Cryptogenic Organizing Pneumonia

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Organizing pneumonia (formerly called bronchiolitis obliterans with organizing pneumonia) is an uncommon type of inflammatory and fibroproliferative lung disorder. Its idiopathic and most frequent form is termed cryptogenic organizing pneumonia. Organizing pneumonia can also be secondary to a variety of causes and particular clinical contexts, which must be carefully ruled out before accepting the diagnosis of cryptogenic organizing pneumonia. Clinically, the disease has usually a subacute onset with cough, dyspnea, fever, fatigue, weight loss, crackles at chest auscultation, and elevated inflammatory biologic markers. Bronchoalveolar lavage typically reveals a mixed pattern alveolitis with increased lymphocytes, neutrophils, and eosinophils. With chest imaging, the most typical features consist of multiple patchy, possibly migratory, alveolar opacities predominating in the subpleural areas. Lung biopsy discloses buds of granulation tissue filling distal airspaces. Response to corticosteroid treatment is usually excellent within days to weeks. Relapses are frequent but can be controlled under moderate doses of prednisone and do not alter the final prognosis.

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