Organizing Pneumonia: Features and Prognosis of Cryptogenic, Secondary, and Focal Variants

doi:10.1001/archinte.1997.00440330057006

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Vol. 157 No. 12, 23 JUNE 1997

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Organizing Pneumonia

Features and Prognosis of Cryptogenic, Secondary, and Focal Variants

Robert H. Lohr, MD; Benoit J. Boland, MD, PhD; William W. Douglas, MD; David H. Dockrell, MD; Thomas V. Colby, MD; Stephen J. Swensen, MD; Peter C. Wollan, PhD; Marc D. Silverstein, MD

Arch Intern Med. 1997;157(12):1323-1329.

Abstract

Background
Organizing pneumonia (OP) is a nonspecific response to manytypes of lung injury. Clinicians frequently encounter pathologyreports of OP in patients with no underlying condition (cryptogenicOP, also known as BOOP or bronchiolitis obliterans OP) or inassociation with drugs or nonpulmonary disease. The goals ofthis study are to describe the clinical course and outcomesin patients with 3 clinical variants of OP.

Methods
A retrospective study of patients with OP seen at the Mayo Clinic,Rochester, Minn, from January 1, 1984, through June 30, 1994,was conducted. Initial features were obtained from medical records.Chest radiographs and pathology specimens were reviewed forthis study. Resolution, relapse, and survival were obtainedfrom medical records and a follow-up patient questionnaire.

Results
Seventy-four patients had pathologically confirmed OP. Organizingpneumonia was classified into 3 clinical groups: symptomaticcryptogenic OP; symptomatic OP related to underlying hematologicmalignant neoplasm, collagen vascular disease, or drugs (secondaryOP); and asymptomatic OP presenting as a focal nodule (focalOP). Thirty-seven patients (50%) had cryptogenic OP and 27 patients(36%) had secondary OP. No difference was found between cryptogenicand secondary OP in type or severity of symptoms, signs, laboratoryand pulmonary function tests, or radiologic or pathologic findings.Corticosteroids were given at a similar initial dose (prednisone,about 50 mg/d). Resolution of symptoms was more frequent inpatients with cryptogenic OP than those with secondary OP. Relapsewas infrequent in both of these groups. Five-year survival washigher in patients with cryptogenic OP (73%) than in secondaryOP (44%), and respiratory-related deaths were more frequentin patients with secondary OP.

Organizing pneumonia was an asymptomatic focal rounded opacityin 10 patients (14%), most often detected on chest radiographand diagnosed on lung biopsy done for suspicion of lung cancer.Patients with focal OP required no treatment and had no relapseor respiratory-related deaths.

Conclusions
Clinical classification of OP is useful to predict clinicalcourse and outcome. Cryptogenic OP most often was a symptomaticbilateral lung process that had an overall favorable prognosiswith prolonged corticosteroid therapy. Patients with secondaryOP had a high mortality rate when the disease was associatedwith predisposing conditions or drugs. Patients with asymptomaticfocal OP had an excellent prognosis.

Arch Intern Med. 1997;157:1323-1329

Footnotes

Affiliations of the authors are given in the acknowledgmentsection at the end of the article.

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