Cryptogenic organising pneumonia – a continuous challenge. Case report

Cryptogenic organising pneumonia (COP) is an interstitial lung disease, with an unknown aetiology. Treatment is based on oral corticotherapy, starting with attack doses given for 2–6 weeks, followed by gradual tapering over a period of 3–6 months. Relapses are common, especially in the first year. A 51-year-old patient, former smoker, without exposure to noxious substances, presented to the hospital in January 2020 with fever, dry cough and malaise. On chest radiography, lesions suggestive of bronchopneumonia were revealed and antibiotic treatment was started. The patient did not respond to treatment and chest Computed tomography (CT) was performed, which detected pulmonary condensations, predominantly with a subpleural disposition, predominantly in the lower lobes, as well as pleural effusion and minimal pericarditis. Due to the unfavourable disease evolution despite treatment and according to other investigation results, COP diagnosis was raised and oral corticotherapy was prescribed, with a favourable response. The patient complained of reappearance of the initial symptoms at dose weaning and she was reassessed by CT in June 2020. The Coronavirus Disease 2019 (COVID-19) pandemic raised the suspicion of a severe acute respiratory syndrome coronavirus-2 (SARS-COV2) infection, which was infirmed later. Corticotherapy was resumed, and at a check-up after 10 months, broncho-alveolar lavage was performed, with results within normal limits. The evolution of the patient was favourable. In conclusion, in the case of a pneumonia in which there is a discrepancy between the clinic, biologic and imagistic (possibly with a migratory pattern) and the response to treatment, COP must also be considered. Relapses are relatively common, and may occur both during corticotherapy dose reduction and after the end of treatment.