Idiopathic bronchiolitis obliterans organizing pneumonia: case review

Bronchiolitis obliteans organizing pneumonia [BOOP] is characterized clinically by a subacute or chronic respiratory illness. The purpose of this study was to describe clinical and radiologic features of Idiopathic [cryptogenic] bronchiolitis obliterans organizing pneumonia. We retrospectively reviewed 11 patients with biopsy proven BOOP at Masih Daneshvari Hospital, for whom well documented clinical and radiographic data were available. The final diagnosis of BOOP was validated if the followings were present. 1] Negative sputum or bronchoalveolar lavage [BAL] analysis for Mycobacterium tuberculosis 2] Open lung biopsy [OLB] or trans-bronchial lung biopsy [TBLB] findings characteristic of BOOP. 3] Negative findings for systemic disorders or associated primary pulmonary lesions such as cancer. 4] Prompt response to steroid therapy. The mean age of patients with BOOP in this case series was 46.3 +/- 24.6 yrs. [range 32-70]; the male/female ratio was 7/4. The clinical pattern in BOOP presentation was more similar to classic sub-acute infectious process: dyspnea in 9 patients [81.8%], fever in 5 [45.4%], and cough in 6 [54.5%]. The symptoms were usually mild. Physical examination showed sparse crackles in 5 patients [45.4%] and wheezing in 7 [63.6%]. The most frequent radiologic patterns were ground glass appearances [63.6%] and diffuse infiltration associated with reticular pattern [27.2%]. In 6 patients chest images showed bilateral distribution. The clinical and radiological manifestation of BOOP in our patients did not differ from other reports. BOOP cases may present a distinct entity like pneumonia. Physicians in charge of these patients were all surprised of BOOP diagnosis by tissue examination. Trans- bronchial lung biopsy specimens along with strongly suggestive clinical and radiologic findings in many cases were adequate for making the diagnosis. We suggest that the diagnosis of BOOP must be considered in any immunocompetent patient with pneumonia with poor or no response to antibiotic therapy

Churg strauss syndrome after introducing oral steroid to inhaler - a report of three cases

The tetrad of bronchial asthma, severe sinusitis, nasal polyp, eosinophilia, and systemic vasculitis is the main feature of allergic granulomatosis and angitis [Churg- Strauss Syndrome]. This vasculitis is usually seen idiopathic in patients with a long history of asthma; oral steroids using steroid inhalers, vaccination and desensitization might be triggering factors. Drugs such as leukotriene receptor antagonists [LTRAS], penicillin, sulphonamides, anticonvulsants and thiazides have also been implicated. By presenting the cases in this article, the authors suggest that some cases of CSS may be partially or totally suppressed by corticosteroid therapy of asthma for long periods and replacing oral steroid by inhaler will reveal a pathologic condition of CSS, called frustes CSS forms. We report three subjects with asthma who had been receiving previously multiple corticosteroid courses for control, but when systemic corticosteroids were discontinued or switched over to steroid inhaler, the patients developed a similar syndrome