In addition, granulation-tissue type fibrosis was observed obstructing the bronchioles and within alveolar spaces, which is compatible with bronchiolitis obliterans organizing pneumonia. In fact, he presented with an acute pneumonic syndrome and did not respond to antibiotics. Migratory infiltrates were subsequently noted highly suggesting eosinophilic pneumonia. The granulomas are poorly demarcated. Because of their strong predilection to occur around bronchioles, they may cause destruction of the bronchiolar wall with resultant cystic change.
Subpleural lesions are common, and rupture of cysts causes pneumothorax.
The institution of corticosteroid therapy in this patient led to almost complete resolution of the pulmonary infiltrates in only one week. This was rather unusual, because patients normally respond slowly and not in the magnitude that this patient did. BOOP, the clinicopathological syndrome, occurs in response to a wide variety of pulmonary injuries, resulting in proliferation of granulation tissue in the lumens of the small conducting airways 5 with preservation of the lung architecture. 4 BOOP should be considered in patients with flu-like symptoms lasting longer than expected with bilateral patchy infiltrates on the CXR and no response to antibiotics, Patients have sometimes a preexisting, associated conditions such as collagen vascular disease, drug or toxin reaction, resolving infections, toxic inhalation, human immunodeficiency virus infection, radiation therapy, thyroiditis, alcoholic cirrhosis, diffuse alveolar damage, and cancer. This is the first case of PHX that has been shown to behave in this rather unusual fashion with migratory infiltrates concomitantly associated with BOOP and also that has such as dramatic symptomatic response to corticosteroid therapy.