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• W2981158324 abstract "SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Organizing pneumonia may be idiopathic or secondary. “Radiation-induced organizing pneumonia” (RIOP) is a rare secondary organizing pneumonia that may occur following radiation therapy. CASE PRESENTATION: A 60 year-old Chinese female never smoker presented with cough for 2 months and right lower zone infiltrates on chest radiograph. She had right breast cancer (pTisN0M0) status post wide excision and radiotherapy 4 months prior. She was initially treated with a course of antibiotics without clinical or radiological improvement. A computed tomography scan showed dense consolidation in the right lower lobe with atoll sign suggestive of organizing pneumonia. She subsequently underwent bronchoscopy and transbronchial lung biopsy. No endobronchial lesions were seen. Bronchoalveolar lavage (BAL) was negative for microbiologic investigations. BAL cell count revealed a lymphocytic (61%) and eosinophilic (20%) pattern. Lung biopsies histology returned as organizing pneumonia. There were inflammatory changes in-keeping with organizing pneumonia. Her clinical history and serologies were negative for autoimmune diseases. She was diagnosed to have RIOP. Her symptoms and radiological infiltrates resolved spontaneously 9 months later without steroid or macrolide treatment. DISCUSSION: The diagnosis of RIOP is established based on the clinico-pathological features and the exclusion of other aetiologies. Radiotherapy induces an inflammatory reaction with cytokine release and fibroblast activation causing lung damage; hence RIOP is highly responsive to steroid treatment, which is the mainstay of treatment. There is, however, a minority of RIOP patients who improve without steroid therapy. This group is associated with a better prognosis and a significantly lower relapse rate. Although they are reported to have a longer symptomatic period of up to 3 months; in view of the potential side effects of steroid, interactions with chemotherapy as well as the high relapse rate with steroid taper, the risk-benefit ratio should be considered before steroid initiation. Macrolide therapy is an alternative, based on limited case reports. CONCLUSIONS: RIOP should be suspected in a symptomatic patient post-radiation therapy with classical radiological signs. As the infiltrates may occur outside of the irradiated volume, the patient may be misdiagnosed as pneumonia. Steroid therapy should be reserved for patients with severe symptoms with due consideration of the risk-benefit ratio. Reference #1: Radiation-Induced Organizing Pneumonia: A Characteristic Disease that Requires Symptom-Oriented Management. Keisuke Otani, Yuji Seo, and Kazuhiko Ogawa. Int J Mol Sci. 2017 Feb; 18(2): 281. PMID: 28134830 Reference #2: Systematic Review of Postradiotherapy Bronchiolitis Obliterans Organizing Pneumonia in Women With Breast Cancer. GARY R. EPLER, a EILEEN M. KELLYb Reference #3: Cryptogenic organizing pneumonia after radiotherapy for breast cancer. Giorgio Fumagalli and Claudio M Sanguinetti. PMID: 22958364 DISCLOSURES: No relevant relationships by Sandra HUI, source=Web Response No relevant relationships by Keng Leong TAN, source=Web Response no disclosure submitted for Lee Wei Chee" @default.
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• W2981158324 date "2019-10-01" @default.
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• W2981158324 title "SPONTANEOUS RESOLUTION OF ORGANIZING PNEUMONIA FOLLOWING RADIATION THERAPY" @default.
• W2981158324 doi "https://doi.org/10.1016/j.chest.2019.08.1588" @default.
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