Acute fibrinous and organizing pneumonia after lung transplantation: A case report of treatment with infliximab and tocilizumab and literature review
Introduction: Acute fibrinous and organizing pneumonia (AFOP) is a severe form of acute lung injury which can occur after lung transplantation. Treatment is empiric, based on immunosuppressive regimens and the mortality rate is very high. Case presentation: We report the case of a young lung transpl...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | Respiratory Medicine Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213007124001825 |
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| author | Christophe Abellan Foteini Ioakeim Alessio Casutt Benoit Lechartier Zisis Balmpouzis Samuel Rotman Leslie Noirez Isabelle Rochat John-David Aubert Angela Koutsokera |
| author_facet | Christophe Abellan Foteini Ioakeim Alessio Casutt Benoit Lechartier Zisis Balmpouzis Samuel Rotman Leslie Noirez Isabelle Rochat John-David Aubert Angela Koutsokera |
| author_sort | Christophe Abellan |
| collection | DOAJ |
| description | Introduction: Acute fibrinous and organizing pneumonia (AFOP) is a severe form of acute lung injury which can occur after lung transplantation. Treatment is empiric, based on immunosuppressive regimens and the mortality rate is very high. Case presentation: We report the case of a young lung transplant (LT) recipient who developed AFOP following a respiratory viral infection while on suboptimal maintenance immunosuppression due to adherence issues. Diagnosis was confirmed by cryobiopsies showing intra-alveolar fibrin balls. Despite high dose systemic corticosteroids, the patient developed severe respiratory failure requiring mechanical ventilation. IV infliximab and tocilizumab were administered. The patient was extubated 11 days later and discharged to home 42 days after intubation with 1L/min O2. She developed severe pleuritic pain needing opioid treatment and died 4 months later. Conclusion: While high-dose systemic corticosteroids remain the first line of treatment, the use of anti TNF-α has shown promising results in case reports. Furthermore, we propose prompt realization of a cytokine panel analysis in both blood and bronchoalveolar lavage to better guide the adjuvant administration of a targeted anti-inflammatory therapy. |
| format | Article |
| id | doaj-art-9324bad258c1437aba4900b1527fc6e7 |
| institution | Kabale University |
| issn | 2213-0071 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Respiratory Medicine Case Reports |
| spelling | doaj-art-9324bad258c1437aba4900b1527fc6e72025-02-09T05:00:20ZengElsevierRespiratory Medicine Case Reports2213-00712025-01-0153102159Acute fibrinous and organizing pneumonia after lung transplantation: A case report of treatment with infliximab and tocilizumab and literature reviewChristophe Abellan0Foteini Ioakeim1Alessio Casutt2Benoit Lechartier3Zisis Balmpouzis4Samuel Rotman5Leslie Noirez6Isabelle Rochat7John-David Aubert8Angela Koutsokera9Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Lung Transplantation Center, Division of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Switzerland; Service of Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Corresponding author. Departement of Intensive Care Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, SwitzerlandDivision of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Lung Transplantation Center, Division of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, SwitzerlandDivision of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Lung Transplantation Center, Division of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Switzerland; Division of Pulmonary Medicine, Department of Medicine, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland; Faculty of Biomedical sciences, Università della Svizzera Italiana (USI), Lugano, SwitzerlandDivision of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Lung Transplantation Center, Division of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, SwitzerlandDivision of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Adult Cystic Fibrosis and CFTR-related disorders Center, Division of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Switzerland; Lung Transplantation Center, Division of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, SwitzerlandService of Clinical Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDivision of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandPediatric Pulmonology Unit, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDivision of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Lung Transplantation Center, Division of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, SwitzerlandDivision of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Adult Cystic Fibrosis and CFTR-related disorders Center, Division of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, Switzerland; Lung Transplantation Center, Division of Pulmonology, Dept of Medicine, Lausanne University Hospital and University of Lausanne, SwitzerlandIntroduction: Acute fibrinous and organizing pneumonia (AFOP) is a severe form of acute lung injury which can occur after lung transplantation. Treatment is empiric, based on immunosuppressive regimens and the mortality rate is very high. Case presentation: We report the case of a young lung transplant (LT) recipient who developed AFOP following a respiratory viral infection while on suboptimal maintenance immunosuppression due to adherence issues. Diagnosis was confirmed by cryobiopsies showing intra-alveolar fibrin balls. Despite high dose systemic corticosteroids, the patient developed severe respiratory failure requiring mechanical ventilation. IV infliximab and tocilizumab were administered. The patient was extubated 11 days later and discharged to home 42 days after intubation with 1L/min O2. She developed severe pleuritic pain needing opioid treatment and died 4 months later. Conclusion: While high-dose systemic corticosteroids remain the first line of treatment, the use of anti TNF-α has shown promising results in case reports. Furthermore, we propose prompt realization of a cytokine panel analysis in both blood and bronchoalveolar lavage to better guide the adjuvant administration of a targeted anti-inflammatory therapy.http://www.sciencedirect.com/science/article/pii/S2213007124001825 |
| spellingShingle | Christophe Abellan Foteini Ioakeim Alessio Casutt Benoit Lechartier Zisis Balmpouzis Samuel Rotman Leslie Noirez Isabelle Rochat John-David Aubert Angela Koutsokera Acute fibrinous and organizing pneumonia after lung transplantation: A case report of treatment with infliximab and tocilizumab and literature review Respiratory Medicine Case Reports |
| title | Acute fibrinous and organizing pneumonia after lung transplantation: A case report of treatment with infliximab and tocilizumab and literature review |
| title_full | Acute fibrinous and organizing pneumonia after lung transplantation: A case report of treatment with infliximab and tocilizumab and literature review |
| title_fullStr | Acute fibrinous and organizing pneumonia after lung transplantation: A case report of treatment with infliximab and tocilizumab and literature review |
| title_full_unstemmed | Acute fibrinous and organizing pneumonia after lung transplantation: A case report of treatment with infliximab and tocilizumab and literature review |
| title_short | Acute fibrinous and organizing pneumonia after lung transplantation: A case report of treatment with infliximab and tocilizumab and literature review |
| title_sort | acute fibrinous and organizing pneumonia after lung transplantation a case report of treatment with infliximab and tocilizumab and literature review |
| url | http://www.sciencedirect.com/science/article/pii/S2213007124001825 |
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