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A case of bronchiolitis obliterans organizing pneumonia in an HIV-infected Korean patient successfully treated with clarithromycin

 In Young Jung  ;  Yong Duk Jeon  ;  Mi-young Ahn  ;  Eunkyong Goag  ;  EunHye Lee  ;  Hea Won Ahn  ;  Jin Young Ahn  ;  Nam Su Ku  ;  June Myung Kim  ;  Jun Yong Choi 
 BMC INFECTIOUS DISEASES, Vol.15 : 280, 2015 
Journal Title
Issue Date
Anti-Bacterial Agents/therapeutic use* ; CD4-Positive T-Lymphocytes ; Clarithromycin/therapeutic use* ; Cryptogenic Organizing Pneumonia/complications ; Cryptogenic Organizing Pneumonia/diagnosis* ; Cryptogenic Organizing Pneumonia/diagnostic imaging ; Cryptogenic Organizing Pneumonia/drug therapy ; Diagnosis, Differential ; Female ; HIV Infections/complications* ; Humans ; Republic of Korea ; Tomography, X-Ray Computed ; Young Adult
HIV ; BOOP ; clarithromycin
BACKGROUND: Bronchiolitis obliterans organizing pneumonia (BOOP) is a type of diffuse interstitial lung disease characterized by the pathology of fibroblastic plugs in the lumens of the respiratory bronchioles, alveolar ducts, and alveoli. The occurrence of BOOP in human immunodeficiency virus (HIV)-infected patients has rarely been described, and there have been no clinical case reports in Korea. CASE PRESENTATION: A 24-year-old female who had been diagnosed with HIV ten years prior was admitted due to a 1-year history of cough and sputum production and a 3-day history of fever. She had poor adherence to anti-retroviral therapy (ART) due to gastrointestinal troubles. At the time of admission, her CD4 T-cell count was 5 cells/mm(3). A high resolution computed tomography (CT) scan showed tiny centrilobular nodules with a tree-in-bud pattern in both lungs. Bacterial culture, Pneumocystis jirovecii polymerase chain reaction (PCR), Aspergillus galactomannan antigen (Ag) assay, and respiratory virus PCR were negative. Rapid chest x-ray improvement was seen after a 7-day treatment with anti-tuberculosis medication, ceftriaxone, and clarithromycin. Miliary tuberculosis seemed unlikely considering the rapid radiologic improvement and negative tuberculosis PCR results. Due to the unknown etiology, we performed video-assisted thoracoscopic surgery (VATS) to determine the cause of the diffuse lung infiltration. Pathologic findings were consistent with BOOP, while tissue acid-fast bacilli (AFB) stain and tuberculosis PCR results were negative. Tuberculosis medication and intravenous ceftriaxone were discontinued, while treatment with clarithromycin monotherapy was sustained. Five months after discharge, the patient was asymptomatic with a normal chest x-ray and as her adherence to ART improved, her CD4 T-cell count rose to 181 cells/mm(3). Clarithromycin was discontinued at that time and the patient is currently receiving regular outpatient follow-up. CONCLUSION: This case suggests that macrolides are a potential treatment option in HIV-infected patients with mild BOOP. In cases that are otherwise unexplained or unresponsive to treatment, BOOP should be taken into consideration and surgical biopsy performed to confirm a diagnosis of BOOP.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Goag, Eun Kyong(곽은경)
Ku, Nam Su(구남수) ORCID logo https://orcid.org/0000-0002-9717-4327
Kim, June Myung(김준명)
Ahn, Mi Young(안미영)
Ahn, Jin Young(안진영) ORCID logo https://orcid.org/0000-0002-3740-2826
Ann, Hea Won(안혜원)
Lee, Eun Hye(이은혜) ORCID logo https://orcid.org/0000-0003-2570-3442
Jeon, Yong Duk(전용덕)
Jung, In Young(정인영)
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
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