A43-21 Organizing Pneumonia in Adolescence: A Unique Clinical Challenge

Abstract Introduction Organizing pneumonia (OP), formerly called bronchiolitis obliterans organizing pneumonia (BOOP), is a distinct histopathological finding characterized by intraluminal organizing fibrosis within small airways and alveolar ducts. It can be idiopathic, termed Cryptogenic Organizing Pneumonia (COP), or secondary to infections, drugs, or autoimmune diseases. OP is generally diagnosed in the 5th or 6th decade of life, with pediatric cases being rare and often presenting as a diagnostic challenge due to overlapping symptoms with common respiratory illnesses. This case highlights an unusual presentation of OP in an adolescent, emphasizing the importance of considering this diagnosis in young patients with persistent respiratory symptoms. Case Description We present a 17-year-old female with a history of ulcerative colitis, needle phobia, Hodgkin’s lymphoma (rapid early responder, on treatment), and recently diagnosed Still’s disease, with a 3-month history of progressive dyspnea and fevers. CT imaging revealed progressive bilateral GGO and a pleural nodule with a reversed halo sign typical of OP. She underwent biopsy of a pleural-based nodule, and pathology showed collapsed lung tissue with admixed acute and chronic inflammatory infiltrate and fibrous plugs consistent with organizing pneumonia. Bronchoscopy with BAL revealed monocytic predominant cells and a negative infectious workup for fungal, viral, and bacterial tests. The patient was transitioned from antibiotics to a prolonged prednisone taper and discharged on 2 L oxygen with outpatient follow-up. Discussion Diagnosing OP in adolescents is challenging due to its rarity and nonspecific symptoms. This case underscores the need for early recognition and histopathological confirmation, as well as the utility of CT in identifying suggestive patterns when initial treatments fail. While the etiology in our patient remained cryptogenic, ruling out secondary causes is crucial. Pathological confirmation through pleural biopsy was instrumental in diagnosis and guiding management. Systemic corticosteroid is the mainstay of therapy, and our patient responded dramatically to prednisone, with marked clinical and radiological improvement within weeks. Conclusion Organizing pneumonia, though uncommon, should be considered in adolescents with subacute respiratory symptoms and characteristic imaging, particularly when unresponsive to antimicrobials. Early recognition and corticosteroid therapy are vital for favorable outcomes, preventing chronic lung damage and reducing morbidity. This case adds to limited literature on OP in the pediatric population, advocating a high index of suspicion in atypical lung disease in teenagers. This abstract is funded by: None