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Open Access Case report

Acute fibrinous and organizing pneumonia associated with influenza A/H1N1 pneumonia after lung transplantation

Claudia Otto1, Daniela Huzly2, Lars Kemna3, Annegret Hüttel4, Christoph Benk5, Siegbert Rieg6, Till Ploenes7, Martin Werner1 and Gian Kayser1*

Author Affiliations

1 Institute of Pathology, University Medical Center Freiburg, Breisacher Strasse 115a, Freiburg, D-79106, Germany

2 Department of Virology, University Medical Center Freiburg, Hermann-Herder Strasse 11, Freiburg, D-79104, Germany

3 Department of Radiology, University Medical Center Freiburg, Hugstetter Strasse 55, Freiburg, D-79106, Germany

4 Department of Pneumology, University Medical Center Freiburg, Hugstetter Strasse 55, Freiburg, D-79106, Germany

5 Department of Cardiovascular Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, Freiburg, D-79106, Germany

6 Department of Thoracic Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, Freiburg, D-79106, Germany

7 Department of Internal Medicine, University Medical Center Freiburg, Hugstetter Strasse 55, Freiburg, D-79106, Germany

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BMC Pulmonary Medicine 2013, 13:30  doi:10.1186/1471-2466-13-30

Published: 19 May 2013

Abstract

Background

Immunocompromised patients, particularly after lung transplantation, are at high risk to develop atypical forms of pulmonary infections including influenza A/H1N1. Acute Fibrinous and Organizing Pneumonia (AFOP) is a special histological pattern in acute respiratory failure with high mortality.

Case presentation

We describe a 66-year-old woman with double lung transplantation in August 2009 due to end stage pulmonary fibrosis. After prolonged weaning and subsequent promising course, she developed atypical pneumonia with diffuse pulmonary infiltrates in both lungs in January 2010. Infection with influenza A/H1N1 virus was verified. The patient rapidly suffered from respiratory insufficiency and died eight days after this diagnosis. The post-mortem revealed especially in the lower parts of the lungs the classical histological pattern of pure AFOP. Molecular analyses of lung tissue were positive for influenza A/H1N1.

Conclusion

To our knowledge we present the first case of AFOP triggered by viral infection, here proven to be influenza virus A/H1N1. Thus, also in the setting of viral infection the highly deadly differential diagnosis of AFOP must be considered.

Keywords:
AFOP; Influenza A/H1N1; Acute lung failure; Lung transplantation; Viral infection