Acute fibrinous and organizing pneumonia in a patient with HIV infection and Pneumocystis jiroveci pneumonia

Acute fibrinous and organizing pneumonia (AFOP) is a disease of the small airways that is characterized by deposition of fibrin within the alveolar spaces. The histological pattern is described as a variant of cryptogenic organizing pneumonia (COP). Although COP has been occasionally described in patients with HIV infection, the variant form, AFOP, has not been previously reported in such patients. This report describes an intriguing case of AFOP in a patient with HIV infection and Pneumocystis jiroveci pneumonia. AFOP was diagnosed after tapering of corticosteroid therapy. This case illustrates that non-infectious pulmonary infiltrates should be considered in the differential diagnosis of lung disease in patients with HIV infection.