Cryptogenic organizing pneumonia associated with pregnancy: A case report

BACKGROUND: Cryptogenic organizing pneumonia (COP), formerly known as bronchiolitis obliterans organizing pneumonia, is an extremely rare disease in pregnancy. In this case, we report on COP diagnosed in recurrent pneumonia that does not respond to antibiotics in pregnant woman. CASE SUMMARY: A 35-year-old woman with no prior lung disease presented with concerns of chest pain with cough, sputum, dyspnea, and mild fever at 11 wk’ gestation. She was diagnosed with community-acquired pneumonia and treated with antibiotics; her symptoms improved temporarily. Four weeks after discharge, she was re-admitted with aggravated symptoms. Chest computed tomography demonstrated multifocal patchy airspace consolidation and ground-glass opacities at the basal segments of the right lower lobe, at the lateral basal segment of the lower lobe, and at the lingular segment of the left upper lobe. Bronchoalveolar lavage revealed an increased lymphocyte count and a decreased CD4/CD8 ratio. Prednisolone (0.5 mg/kg/d) was administered for 10 d after the second admission. Dyspnea improved after 3 d of steroid treatment and other symptoms improved on the 5(th) day of steroid administration. Post-delivery transbronchial lung biopsy further revealed the presence of granulation tissue with fibroblasts in small-bronchiole lumens. CONCLUSION: This case suggests that it is important to differentiate COP from atypical pneumonia in the deteriorated condition despite antibiotic treatment.