Paraneoplastic acute fibrinous and organizing pneumonia from lymphoma completely responding to bendamustine-rituximab.
Thomas CrowhurstPratyush GiriCaroline SmithPhan NguyenPaul ReynoldsPublished in: Respirology case reports (2020)
Acute fibrinous and organizing pneumonia (AFOP) is a rare histopathological pattern of lung injury characterized by prominent fibrin deposition in alveolar spaces. It may be idiopathic or associated with medications, connective tissue disease, infection, environmental exposures, transplantation, and malignancy. There is no proven treatment but multiple reports describe response to corticosteroids. We report the case of a 65-year-old male never-smoker with a 15-month history of dry cough, dyspnoea, anorexia, and night sweats only partially responsive to doxycycline and oral prednisolone. Computed tomography chest demonstrated adenopathy on both sides of the diaphragm and patchy consolidation in a peribronchovascular and subpleural distribution with lower zone predominance. Axillary node biopsy revealed low-grade non-Hodgkin's lymphoma. Lung biopsy showed AFOP but no lymphoma. Complete pulmonary and neoplastic responses were achieved with bendamustine-rituximab. We report a compelling instance of paraneoplastic AFOP responding to chemotherapy for lymphoma with very limited use of corticosteroids.
Keyphrases
- diffuse large b cell lymphoma
- low grade
- respiratory failure
- computed tomography
- liver failure
- ultrasound guided
- lymph node
- chronic lymphocytic leukemia
- high grade
- hodgkin lymphoma
- emergency department
- pulmonary hypertension
- fine needle aspiration
- mechanical ventilation
- mesenchymal stem cells
- magnetic resonance imaging
- air pollution
- positron emission tomography
- risk assessment
- sentinel lymph node
- cancer therapy
- neoadjuvant chemotherapy
- hepatitis b virus
- locally advanced
- depressive symptoms
- adverse drug
- early stage
- drug delivery
- intensive care unit
- human health
- sleep quality
- community acquired pneumonia
- chemotherapy induced