Sibel YURT, Lütfiye KILIÇ, Güngör ÇAMSARI, Gülcihan Zehra ÖZKAN, Elif Yelda NİKSARLIOĞLU, Nur Dilek BAKAN

Cryptogenic organizing pneumonia: clinical and radiological features, treatment outcomes of 17 patients, and review of the literature

Background/aim: We evaluated patients with cryptogenic organizing pneumonia (COP) who attended our clinic. Materials and methods: We retrospectively investigated the clinical and radiological findings, diagnostic methods, treatment, and follow-up outcomes of 17 patients who had been histopathologically diagnosed with COP. Results: The mean age of the patients was 49.8 ± 10.4 years. The most common symptom was cough (n = 15; 88.2%) and the most common radiological finding (n = 10) was consolidation in the inferior lobes on thoracic computed tomography. The diagnosis of COP was made by open lung biopsy in 11 (64.7%) patients, transbronchial biopsy in 5 (29.4%), and video-assisted thoracoscopic surgery biopsy in 1 (5.9%). The mean follow-up period was 28.7 ± 25.0 (range: 3 85) months. Twelve patients received oral corticosteroid therapy and seven of them improved without any fibrotic changes. One patient refused treatment; a chest radiography of that patient was found to be normal at the end of the 20-month follow-up period. Three patients received no other therapy, as the lesion had been completely excised. Conclusion: Common symptoms included cough and dyspnea, while the main radiological presentation of COP was consolidation. Corticosteroids are a good treatment option in general, but relapse may occur.

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1. Colby TV. Pathologic aspects of bronchiolitis obliterans organizing pneumonia. Chest 1992; 102: 38S-43S.
2. Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2013; 188: 733-748.
3. Oymak FS, Demirbas HM, Mavili E, Akgun H, Gulmez I, Demir R, Ozesmi M. Bronchiolitis obliterans organizing pneumonia. Respiration 2005; 72: 254-262.
4. Kıter G, Yuncu G, Bir F, Karabulut N, Özkurt S, Evyapan F. Cryptogenic organizing pneumonia: two cases and an update. Toraks Dergisi 2008; 9: 43-48 (in Turkish with English abstract).
5. Kivanc T, Ekici ZU, Dogan CR, Kiyici H, Eyuboglu FO. Cryptogenic organising pneumonia: four cases with different radiological manifestations. Eurasian J Pulmonol 2011; 13: 114-120.
6. Nishino M, Mathai SK, Schoenfeld D, Digumarthy SR, Kradin RL. Clinicopathologic features associated with relapse in cryptogenic organizing pneumonia. Hum Pathol 2014; 45: 342- 351.
7. Cottin V, Cordier JF. Cryptogenic organizing pneumonia. Semin Respir Crit Care Med 2012; 33: 462-475.
8. Cordier JF, Costabel U, du Bois R. Cryptogenic organizing pneumonia. Orphanet Encyclopedia, October 2004. Available online at http://www.orpha.net/consor/cgi-bin/OC_Exp. php?Expert=1302.
9. Wells AU. Cryptogenic organizing pneumonia. Semin in Respir Crit Care Med 2001; 22: 449-459.
10. Cordier JF. Cryptogenic organizing pneumonia. Eur Respir J 2006; 28: 422-446.
11. Lazor R, Vandevenne A, Pelletier A, Leclerc P, Court-Fortune I, Codier JF. Cryptogenic organizing pneumonia: characteristics of relapses in a series of 48 patients. Am J Respir Crit Care Med 2000; 162: 571-577.
12. King TE Jr, Mortenson RL. Cryptogenic and organizing pneumonitis. The North American experience. Chest 1992; 102: 8S-13S.
13. Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M, Aswad B, Karagianidis N, Kastanakis E, Braman SS, Polychronopoulos V. Cryptogenic and organizing pneumonia. Chest 2011; 139: 893-900.
14. Codier JF, Loire R, Brune J. Idiopathic BOOP: definition of characteristic clinical profiles in a series of 16 patients. Chest 1989; 96: 999-1004.
15. Cordier JF. Cryptogenic organizing pneumonitis. Bronchiolitis obliterans organizing pneumonia. Clin Chest Med 1993; 14: 677-692.
16. Yoo JW, Song JW, Jang SJ, Lee CK, Kim MY, Lee HK, Jegal Y, Kim DS. Comparison between cryptogenic organizing pneumonia and connective tissue disease-related organizing pneumonia. Rheumatology 2011; 50: 932-938.
17. Sara AG, Hamdan AJ, Hanaa B, Nawaz KA. Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review. Ann Thorac Med 2008; 3: 67-75.
18. Kim SJ, Lee KS, Ryu YH, Yoon YC, Choe KO, Kim TS, Sung KJ. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implication. AJR Am J Roentgenol 2003; 180: 1251-1254.
19. Maimon N. A 47-year-old female with shortness of breath and reversed halo sign. Eur Respir Rev 2010; 19: 1251-1254.
20. Lee JW, Lee KS, Lee HY, Chung MP, Yi CA, Kim TS, Chung MJ. Cryptogenic organizing pneumonia: serial high resolution CT findings in 22 patients. AJR Am J Roentgenol 2010; 195: 916- 922.
21. Umeda Y, Demura Y, Ishizaki T, Ameshima S, Miyamori I, Saito Y, Tsuchida T, Fujibayashi Y, Okazawa H. Dual-time point 18F-FDG PET imaging diagnosis of disease type and disease activity in patients with idiopathic interstitial pneumonia. Eur J Nucl Med Mol Imaging 2009; 36: 1121-1130.
22. Tateishi U, Hasegawa T, Seki K, Terauchi T, Moriyama N, Arai Y. Disease activity and 18F-FDG uptake in organising pneumonia: semi-quantitative evaluation using computed tomography and position emission tomography. Eur J Nucl Med Mol Imaging 2006; 33: 906-912.
23. Kim SJ, Lee KS, Ryu YH, Yoon YC, Choe KO, Kim TS, Sung KJ. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol 2003; 180: 1251-1254.
24. Lee KS, Kullnig P, Hartman TE, Muller NL. Cryptogenic organizing pneumonia: CT findings in 43 patients. AJR Am J Roentgenol 1994; 162: 543-546.
25. Muller NL, Staples CA, Miller RR. Bronchiolitis obliterans organizing pneumonia: CT features in 14 patients. AJR Am J Roentgenol 1990; 154: 983-987.
26. Lee JS, Lynch DA, Sharma S, Brown KK, Muller NL. Organizing pneumonia: prognostic implication of high-resolution computed tomography features. J Comput Assist Tomogr 2003; 27: 260-265.
27. Stover DE, Mangino D. Macrolides: A treatment alternative for bronchiolitis obliterans organizing pneumonia. Chest 2005; 128: 3611-3617.
28. Patnak V, Kuhn JM, Durham C, Funkhouser WK, Henke DC. Macrolide use leads to clinical and radiological improvement in patients with cryptogenic organizing pneumonia. Ann Am Thorac Soc 2014; 11: 87-91.
29. Radzikowska E, Wiatr E, Gawryluk D, Langfort R, Bestry I, Chabowski M, Roszkowski K. Organizing pneumonia clarithromycin treatment. Pol Pneumonol Allergol 2008; 76: 334-339.
30. Izumi T, Kitaichi M, Nishimura K, Nagai S. Bronchiolitis obliterans organizing pneumonia: clinical features and differential diagnosis. Chest 1992; 102: 715-719.