Correspondence

Bronchiolitis Obliterans with Organizing Pneumonia in AIDS

N Engl J Med 1995; 332:273January 26, 1995

Article

To the Editor:

We report the case of a patient with AIDS who had bronchiolitis obliterans with organizing pneumonia. Although this situation is recognized in other settings, physicians should be aware of the possibility in patients with AIDS.1,2

A 30-year-old man with human immunodeficiency virus infection was admitted to the hospital with cough, fever, and pulmonary infiltrates. He was treated with erythromycin and trimethoprim–sulfamethoxazole, but hypoxic respiratory failure developed. A chest film (Figure 1Figure 1Chest Radiograph (Anteroposterior View) Showing Bilateral Diffuse Alveolar Infiltrates.) showed bilateral diffuse alveolar infiltrates compatible with bacterial pneumonia, Pneumocystis carinii pneumonia, tuberculosis, or heart failure. The patient's CD4 count was 77 per cubic millimeter. Blood cultures showed no growth. Bronchoalveolar lavage was negative for acid-fast bacilli, fungus, legionella, and P. carinii.

After four weeks of antibiotic therapy and ventilatory support, the patient continued to be febrile, and his pulmonary infiltrates worsened. A transbronchial-biopsy specimen showed bronchiolitis obliterans with organizing pneumonia (Figure 2Figure 2Transbronchial-Biopsy Specimen of the Lung, Showing Immature Collagenous Tissue within Air Spaces (Arrows).). Bronchoalveolar lavage revealed a predominance of lymphocytes (45 percent). This finding may indicate that the inflammatory process is chronic and may point to a favorable response to corticosteroids. Within 48 hours of the start of corticosteroid treatment, the patient's condition was markedly improved. He was extubated four days later and sent home within two weeks.

Bronchiolitis obliterans with organizing pneumonia may be a common histopathologic response to various underlying conditions. It is unclear in this patient whether the cause was postinfectious or idiopathic. The cells and cytokines responsible for this problem are not known.3 Because bronchiolitis obliterans with organizing pneumonia is potentially treatable, timely diagnosis — by lung biopsy — is important in patients with AIDS. It is also possible that some clinical improvement in patients with severe P. carinii pneumonia who are treated with corticosteroids is related to incidental treatment of this pneumonia.

Jos Joseph, M.D.
Russell A. Harley, M.D.
Michael D. Frye, M.D.
Medical University of South Carolina, Charleston, SC 29425

3 References

1. 1

   Allen JN, Wewers MD. HIV-associated bronchiolitis obliterans organizing pneumonia. Chest 1989;96:197-198
   CrossRef | Web of Science | Medline

2. 2

   Liote H, Porte JM, Postal MJ, De Lassalle EM, Derenne JP. Bronchiolite oblitérante, pneumocytose et infection par le V.I.H. Rev Mal Respir 1990;7:603-607
   Web of Science | Medline

3. 3

   Epler GR, Colby TV, McLoud TC, Carrington CB, Gaensler EA. Bronchiolitis obliterans organizing pneumonia. N Engl J Med 1985;312:152-158
   Full Text | Web of Science | Medline

Citing Articles (3)

Citing Articles

1. 1

   Miguel Marcos, Judith Navarro, José M. Miró, Asunción Moreno. (2008) Neumonía organizada criptogenética en paciente con infección por el VIH y buen estado inmunológico. Enfermedades Infecciosas y Microbiología Clínica 26:8, 531
   CrossRef

2. 2

   Roman Kleindienst, Falko Fend, Christian Prior, Raimund Margreiter, Wolfgang Vogel. (1999) Bronchiolitis obliterans organizing pneumonia associated with Pneumocystis carinii infection in a liver transplant patient receiving tacrolimus. Clinical Transplantation 13:1, 65-67
   CrossRef

3. 3

   F Díaz, J. Collazos, E. Martinez, J. Mayo. (1997) Bronchiolitis obliterans in a patient with HIV infection. Respiratory Medicine 91:3, 171-173
   CrossRef