D24-24 Transbronchial Cryobiopsy via Robot-assisted Bronchoscopy Revealing Cryptogenic Organizing Pneumonia

Abstract Introduction Organizing pneumonia (OP) is a rare pulmonary pathology (∼1-3/10,000), characterized histologically by fibroblastic plugs (Masson bodies) filling alveoli and alveolar ducts. When no underlying cause is identified, it is termed cryptogenic organizing pneumonia (COP). Imaging is variable, often showing patchy consolidations and peribronchovascular ground-glass opacities, which can mimic multifocal pneumonia and delay diagnosis. Tissue sampling is often required, but traditional surgical biopsies carry morbidity. Minimally invasive approaches, including robot-assisted transbronchial cryoprobe biopsy, offer a safe, targeted alternative. Case A 60-year-old woman with recurrent diverticulitis (post-colectomy), cholelithiasis, thyroid nodules, chronic lower extremity lymphatic changes, and a 45 pack-year smoking history initially presented in 2023 with exertional dyspnea. CT chest showed mild para-septal emphysema; PFTs demonstrated mild obstruction that later resolved. In August 2025, she developed fever and worsening dyspnea. Chest x-ray revealed multifocal alveolar infiltrates; oral antibiotics were ineffective. Abdominal CT for unrelated pain incidentally revealed bilateral lower lobe opacities, prompting hospitalization for presumed pneumonia. CT chest demonstrated bilateral ground-glass opacities and peribronchovascular consolidations. Infectious workup, including BAL cultures, was negative. At follow-up, she reported a month-long rash, recurrent oral ulcers, hand arthralgias, fingertip rashes with nail splitting, myalgias, and ocular irritation. Labs showed elevated ESR and CRP with transient eosinophilia. Autoimmune workup was largely negative except borderline anti-SSA; ANA was 1:80. Rheumatology noted symptom resolution on steroids. Given persistent systemic features and negative infectious and hypersensitivity evaluations, she underwent Ion Robot-assisted navigational bronchoscopy with BAL, FNA, and transbronchial cryoprobe biopsies targeting the right lower lobe. Histopathology revealed rare fibroblastic plugs, supporting OP. She was started on a steroid taper with planned follow-up imaging and PFTs. Discussion This case underscores the diagnostic challenges of OP, which can mimic multifocal pneumonia and present with systemic inflammatory features. Robot-assisted transbronchial cryoprobe biopsy enabled safe, precise sampling of affected lung tissue, avoiding surgical biopsy morbidity while providing definitive histopathologic confirmation. While COP is idiopathic, secondary causes—including infection, drugs, environmental exposures, and autoimmune disease—must be considered; borderline autoantibodies and persistent inflammation raise the possibility of evolving autoimmune pathology. Minimally invasive, precision-guided biopsy can expedite diagnosis, guide therapy, and reduce procedural risk. Clinicians should consider OP in patients with non-resolving pneumonia-like infiltrates, particularly when systemic features are present, and leverage advanced interventional tools to obtain tissue safely. This abstract is funded by: None