C42: Unique Case of BOOP in SARS-CoV-2

Description

Bronchiolitis, the non-specific inflammation of the bronchioles, has features of cellular and/or fibroblast infiltrates. Bronchiolitis obliterans with organizing pneumonia (BOOP) has features of both cellular proliferation and increased fibroblast activity. While this condition has been reported in the setting of many conditions it has been associated with connective tissue disorder, radiation therapy, transplant rejection, inhalation injury and viral pneumonia; when a cause is not determined as in the case of most patients they are categorized as cryptogenic organizing pneumonia (COP). Symptoms of BOOP can range from flu-like to hemoptysis and are typically found in patients ranging from 40-60 years of age without significant variability in gender. A 51-year-old female with a past medical history of hypothyroidism and smoking presented with symptoms of nonproductive dry cough and hypoxia was diagnosed with allergies and viral pneumonia with SARS-COV-2. Here we present a case of constrictive bronchiolitis obliterans with features of cellular organization with foamy macrophages giving an organizing pneumonia-like features (BOOP) in the presence of SARS-COV-2 pneumonia. Histopathology analysis of the left lower lobe transbronchial biopsy demonstrated patchy organizing pneumonia characterized by mucopolysaccharide rich plugs of proliferating fibroblasts in alveolar spaces accompanied by a patchy mild chronic and focally acute inflammatory infiltrate with reactive type II pneumocytes and intra-alveolar foamy macrophages. Laboratory analysis did not demonstrate convincing evidence for connective tissue disorder but did demonstrate evidence for SARS-COV-2 antibodies. There was significant reversibility of obstruction on bronchodilation along with preserved restrictive changes on pulmonary function testing. The patient was treated with prednisone 40 mg per day for four weeks, followed by a gradual taper over 2 weeks with improvement in dyspnea and oxygenation. In patients presenting with combined features of restriction and obstruction on PFTs with the presence of SARS-COV-2 or those having initial improvement and then worsening of respiratory status with imaging features consistent with diffuse interstitial lung disease it is important to have BOOP as a differential as early treatment with steroid therapy can be curative.

Disciplines

Clinical Trials | Health and Medical Administration | Health and Physical Education | Health Services Research | Medical Education | Medical Sciences | Medicine and Health Sciences | Nursing | Primary Care | Pulmonology | Respiratory Tract Diseases | Scholarship of Teaching and Learning | Teacher Education and Professional Development | Virus Diseases

Document Type

Event

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C42: Unique Case of BOOP in SARS-CoV-2

Bronchiolitis, the non-specific inflammation of the bronchioles, has features of cellular and/or fibroblast infiltrates. Bronchiolitis obliterans with organizing pneumonia (BOOP) has features of both cellular proliferation and increased fibroblast activity. While this condition has been reported in the setting of many conditions it has been associated with connective tissue disorder, radiation therapy, transplant rejection, inhalation injury and viral pneumonia; when a cause is not determined as in the case of most patients they are categorized as cryptogenic organizing pneumonia (COP). Symptoms of BOOP can range from flu-like to hemoptysis and are typically found in patients ranging from 40-60 years of age without significant variability in gender. A 51-year-old female with a past medical history of hypothyroidism and smoking presented with symptoms of nonproductive dry cough and hypoxia was diagnosed with allergies and viral pneumonia with SARS-COV-2. Here we present a case of constrictive bronchiolitis obliterans with features of cellular organization with foamy macrophages giving an organizing pneumonia-like features (BOOP) in the presence of SARS-COV-2 pneumonia. Histopathology analysis of the left lower lobe transbronchial biopsy demonstrated patchy organizing pneumonia characterized by mucopolysaccharide rich plugs of proliferating fibroblasts in alveolar spaces accompanied by a patchy mild chronic and focally acute inflammatory infiltrate with reactive type II pneumocytes and intra-alveolar foamy macrophages. Laboratory analysis did not demonstrate convincing evidence for connective tissue disorder but did demonstrate evidence for SARS-COV-2 antibodies. There was significant reversibility of obstruction on bronchodilation along with preserved restrictive changes on pulmonary function testing. The patient was treated with prednisone 40 mg per day for four weeks, followed by a gradual taper over 2 weeks with improvement in dyspnea and oxygenation. In patients presenting with combined features of restriction and obstruction on PFTs with the presence of SARS-COV-2 or those having initial improvement and then worsening of respiratory status with imaging features consistent with diffuse interstitial lung disease it is important to have BOOP as a differential as early treatment with steroid therapy can be curative.