Cryptogenic organizing pneumonia associated with invasive pulmonary aspergillosis: a case report and review of the literature.

BACKGROUND: Concomitant occurrence of invasive pulmonary aspergillosis (IPA) with cryptogenic organizing pneumonia (COP) is scarce. Here, we report a case where COP was a presenting feature in a patient with diagnosed IPA, and review additional 58 COP patients reported in the literature from 1988 through 2013. CASE OUTLINE: The study was reviewed and approved by the Institutional Ethics Committee of Shanghai Tenth People's Hospital of Tongji University and was conducted in compliance with the Helsinki Declaration. Written informed consent was obtained from patient. A 56-year-old man presenting with productive cough for several weeks and unremitting high fever for a week was hospitalized with an initial clinical diagnosis of pneumonia, for which antibiotics were prescribed but did not work. Seeing that the condition progressed both clinically and radiographically, bronchoscopy, bronchoalveolar lavage and lung biopsy were performed, and the diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-existence was made. Initially, the patient responded to steroid pulse therapy and voriconazole treatment, and his condition was partially improved. However, the patient's condition deteriorated progressively 5 months after the disease onset and the patient died during the third admission due to respiratory failure and the adverse reactions of coriaceous hormone therapy.
CONCLUSION: The diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-occurrence depends on clinical, radiological and histological presentations. Similarities with other disease processes could lead to a delayed diagnosis or misdiagnosis. The present case suggests that clinicians should be alert to this disease in their clinical practices.