What does this research mean for the field?

While cryptogenic organizing pneumonia (COP) typically has a favorable prognosis and responds well to glucocorticoids, it can manifest as a rapidly progressive, severe disease refractory to medical therapy and requiring advanced interventions such as ECMO and lung transplantation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This report aims to highlight the challenges in diagnosing and treating cryptogenic organizing pneumonia (COP) while discussing severe cases.

May 20, 2026

A43-20 Speeding COP: An Unusually Severe Case of Rapidly Progressive Cryptogenic Organizing Pneumonia

Key Points

This report aims to highlight the challenges in diagnosing and treating cryptogenic organizing pneumonia (COP) while discussing severe cases.
Case presentation of a 64-year-old man with cryptogenic organizing pneumonia
Utilized imaging, bronchoalveolar lavage with biopsy for diagnosis
Addressed treatment challenges including glucocorticoids and subsequent complications.
Patient presented with severe respiratory failure and worsening ground-glass opacities after glucocorticoid initiation.
Underwent successful venovenous-extracorporeal membrane oxygenation and lung transplantation.
Post-transplant histology revealed diffuse organizing alveolar destruction with full recovery after 14 months.

Abstract

Abstract Organizing pneumonia (OP) refers to the pattern of repair/scarring made evident radiologically and histologically in the setting of insult to lung tissue. Secondary OP is due to insults like infection, inhalational injuries, radiation, or drug-induced interstitial disease, while cryptogenic OP (COP) denotes an absence of identifiable insult. Though clinical and radiologic manifestations may be severe, prognosis is generally favorable, with several reviews reporting 5-year mortality 90%, generally rapid responsiveness to glucocorticoid therapy. We present a case of a 64-year-old man without significant past medical history who originally presented with OP’s typical subacute flu-like illness, largely unresponsive to several courses of antibiotics. He transiently improved once started on moderate-dose glucocorticoids, but had worsening respiratory failure within days. Serial imaging demonstrated worsening ground-glass opacities with eventual fibrosis and traction bronchiectasis, while infectious workup, BAL with biopsy, and autoimmune workup remained unrevealing. The diagnosis of COP was made by biopsy of the RML, which was consistent with organizing pneumonia in the absence of malignancy, granulomas, or the presence of other pathologies that would cause OP. Further immunosuppression was pursued at the cost of decompensation in the setting of new Pneumocystis pneumonia despite Bactrim prophylaxis. The patient successfully underwent venovenous-extracorporeal membrane oxygenation (VV-ECMO) cannulation and bilateral lung transplant, with the explanted lungs only revealing diffuse organizing alveolar destruction. He has since made a full recovery and is 14 months post-transplant. This report is intended to discuss early identification of OP, treatment of secondary OP vs. that of COP, and factors that impact course severity, likelihood of relapse, and mortality. Additionally, we discuss the rising role of COVID-19 in delayed manifestations of OP, and address the concern for Pneumocystis pneumonia in the setting of protracted courses of high-dose glucocorticoids. This abstract is funded by: none

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A43-20 Speeding COP: An Unusually Severe Case of Rapidly Progressive Cryptogenic Organizing Pneumonia

Key Points

Abstract

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