Cryptogenic and Secondary Organizing Pneumonia: Clinical Presentation, Radiographic Findings, Treatment Response and Prognosis.
Chest. 2010 Aug 19;
Authors: Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M, Aswad B, Karagianidis N, Kastanakis E, Braman SS, Polychronopoulos V
ABSTRACT Organizing pneumonia (OP) is a distinct clinical and pathological entity. This condition can be cryptogenic (COP) or secondary to other known etiologies (secondary OP). In the present study, we reviewed the features associated with COP and secondary OP in patients from two teaching hospitals. METHODS: The medical records of 61 patients with biopsy proven OP were retrospectively reviewed. 40 patients were diagnosed with COP and 21 patients with secondary OP. The clinical presentation, radiolographic studies, pulmonary function tests (PFT), laboratory data, bronchoalveolar lavage (BAL) findings, treatment and outcome were analyzed. RESULTS: The mean age at presentation was 60,46 +/- 13,57 years. Malaise, cough, fever, dyspnea, bilateral alveolar infiltrates and a restrictive pattern were the most common symptoms and findings. BAL lymphocytosis was observed in 43,8% of patients with OP. The relapse rate and mortality rate after one year of follow-up were 37,8% and 9,4% respectively. The in-hospital mortality was 5,7 %. The clinical presentation and radiographic findings did not differ significantly between patients with COP and secondary OP. A mixed PFT pattern (obstructive and restrictive physiology) and lower blood levels of Na, K, platelets, albumin, protein and pH were observed among patients with secondary OP. Higher blood levels of creatinine, bilirubin, PaCO2 and BAL lymphocytes were also more common among patients with secondary OP. There were no differences in the relapse rate or mortality between patients with COP and secondary OP. The one-year mortality correlated with an elevated ESR, low albumin and low haemoglobin levels. CONCLUSIONS: The clinical and radiographic findings in patients with COP and secondary OP are similar and nonspecific. While certain laboratory abnormalities are more common in secondary OP and can be associated with worse prognosis, they are likely due to the underlying disease. COP and secondary OP have similar treatment response, relapse rates and mortality.
PMID: 20724743 [PubMed - as supplied by publisher]