The Drug-Induced Respiratory Disease Website
(Fr: Pneumopathie organisée (BOOP). See also under If and XVc. Exclusion of an infection is crucial, Typically, wandering areas of consolidation on imaging. Note of CAUTION: several recent publications described OP cases without lung pathology being documented. Basically, imaging is not reliable enough to confidently diagnose OP and such reports should be viewed with some caution and reservation (PMID 27565934, 28481788) (BOOP sine pathology. Organizing pneumonia is a clinical and a pathologic syndrome that may develop idiopathically or in association with an infection or hematologic, CTD or bowel disease unexposed to therapy drugs (PMID 16704928). Regardless of etiology, OP manifests with cough, fever, dyspnea and areas of parenchymal consolidation which may fluctuate or wander on serial imaging, multiple nodules, a mass or masses. Short of withdrawing the causal drug, serial relpases may occur even with continued corticosteroid therapy. Mild OP cases may not require steroid therapy. Suggestive OP features: 1) Migratory pulmonary opacities on sequential imaging, 2) Confirmatory pathology (not required in every case), 3) Lack of prominent BAL or tissue eosinophilia 4) Exposure to a compatible drug 5) Abatement of all signs and symptoms following drug discontinuance without corticosteroid therapy 6) Absence of relapse over at least one year follow-up. OP cases diagnosed on imaging only are considered low evidence (e.g. PMID 21761513). Only pathologically OP cases are included here and under OP in XV 'Pathology' . See also under 'Relapsing pneumonitis'.
Publications
Nitrofurantoin-induced pulmonary reaction involving respiratory symptoms: case report.
The Canadian journal of hospital pharmacy 2011 Sep;64;362-5 — 2011 Sep — 362-5
Nitrofurantoin-associated bronchiolitis obliterans organizing pneumonia: report of a case.
Canadian respiratory journal 2008 Sep;15;311-2 — 2008 Sep — 311-2
Bronchiolitis interstitial pneumonitis: a pathologic study of 31 lung biopsies with features intermediate between bronchiolitis obliterans organizing pneumonia and usual interstitial pneumonitis, with clinical correlation.
Annals of diagnostic pathology 2008 Jun;12;171-80 — 2008 Jun — 171-80
Drug-associated organizing pneumonia: high-resolution CT findings in 9 patients.
Journal of thoracic imaging 2006 Mar;21;22-6 — 2006 Mar — 22-6