BRONCHIOLITIS OBLITERANS ORGANIZED PNEUMO NIA - REVIEW OF 6 CASES

Background. Bronchiolitis obliterans with organizing pneumonia (BOOP) is recently described clinicopathological entity, with only a few seri es of patients reported. Terminology is unclear, which together with i ts rarity lead to a poor understanding of the entity. Objective. To re view the clinical, radiological, and laboratory features and the respo nse to therapy in cases of BOOP in our environment. Materials and meth ods. A total of 463 lung biopsies were obtained at Mostoles Hospital, Madrid, from 1992 to 1994. In six cases the anatomo-pathological diagn osis was BOOP. Clinical histories of these patients were reviewed. Res ults. Six patients were diagnosed with BOOP. From these six patients, four (66%) were female, with a mean age of 59 years (45-74 years). Thr ee patients (50%) were smokers. BOOP was idiopathic in four cases (66% ) and secondary to rheumatoid arthritis in one (17%) and Legionella pn eumonia in another patient (17%). Patients presented with cough and dy spnea (100%), chest pain and constitutional syndrome (66%) and fever ( 34%) of one to eight weeks evolution. Laboratory data included: increa sed ESR (100%), abnormal levels of liver enzymes (83%), hypoxemia (83% ) and abnormal spirometry (50%). Radiological studies demonstrated alv eolar infiltrates in 83%, predominantly in lower lobes, which were of a migratory nature in 33%. CT, performed in five patients, demonstrate d alveolar infiltrates in all patients, which were bilateral and perip heric in two. Transbronchial biopsy was diagnostic in five cases, and in one patient thoracotomy had to be performed. One patient died (17%) ; the remaining patients (83%) improved with steroids, although 34% re lapsed. Mean follow-up time was eleven months (5-24 months). Conclusio ns. BOOP observed in our environment is a rare entity, usually of an i diopathic nature, which presents with characteristic clinical course a nd laboratory findings. Transbronchial biopsy is diagnostic in many pa tients. The clinical course is good with steroids in most patients, al though relapses are common.