macrophages,
granulocytes, and lymphocytes. Transbronchial biopsy
showed intra-alveolar young fibrosis tissue and
granulocytic infiltrate, consistent with organizing pneumonia.
The pathologist also found a few non-necrotizing granulomas
in the transbronchial biopsy specimen (Fig. 2).
The empiric antibiotic therapy was stopped, and she was
started on anti-tuberculosis therapy (isoniazid, ethambutol,
rifampin, and pyrazinamide), which improved her respiratory
symptoms. We then added prednisone (60 mg daily).
Her shortness of breath ameliorated and her erythrocyte
sedimentation rate and C-reactive protein became normal.
She was discharged on hospital day 30, with a recommendation
to continue the isoniazid, ethambutol, and rifampin
for 17 months, and to taper the prednisone dose over
9 months. Two months after hospital discharge, radiograph
showed complete clearing of the pulmonary findings.
She felt well, without notable cough or dyspnea.
Discussion
BOOP can be induced by various cause