Work

Acute fibrinous and organizing pneumonia presents as right lung upper lobe cavitary lesion: Case report and literature review

Year: 2025

Type: article

Abstract: RATIONALE: The upper lobe of the right lung, due to its unique anatomical structure that is prone to tumor occurrence, poses a challenge for the differential diagnosis of focal cavitary lesions. Cases of acute fibrinous and organizing pneumonia presenting as cavitary lesions in the upper lobe of the right lung are extremely rare in the previous literature. PATIENT CONCERNS: This case presents a 59-year-old man who was hospitalized with a cough, phlegm, and low-grade fever after a bout of strenuous exercise and exposure to rain. A chest computed tomography (CT) revealed a cavitary lesion (lesions maximum diameter 9 cm, hollow maximum diameter of 3.5 cm) in the upper lobe of the right lung. DIAGNOSES: Initially, he was incorrectly diagnosed with community-acquired pneumonia, and the empirical anti-infective and antiviral therapies proved ineffective. The flexible bronchoscopy lavage fluid showed negative results in metagenomic Next-Generation Sequencing (mNGS), but the pathological micrograph indicated a suspected diagnosis of acute fibrinous and organizing pneumonia. INTERVENTIONS: He was taken off antibiotics, changed to 40 mg of methylprednisolone intravenously each day. OUTCOMES: Six days after receiving methylprednisolone, the cough disappeared. A reexamination chest CT showed a significant reduction of the lesion. Additionally, the patient did not report any discomfort during the 6 months of follow-up. LESSONS: This case highlights the particular characteristics of the focal cavitary lesions in the upper lobe of the right lung and emphasizes the role of liquid-based cytology in the diagnosis of acute fibrinous and organizing pneumonia, rather than mNGS.

Source: Medicine

DOI: 10.1097/md.0000000000044915