Cryptogenic organising pneumonia or acute fibrinous and organising pneumonia?

To the Editors:

In a recent issue of the European Respiratory Journal, Chee et al. 1 present a case that was diagnosed and treated as cryptogenic organising pneumonia. We have a few comments about this case.

First, histology is described as follows: “…diffuse intra-alveolar exudate of granular, fibrinous material…”. Organising pneumonia pattern, the histological hallmark of cryptogenic organising pneumonia, is characterised by intra-alveolar buds of granulation tissue. Recently, a new anatomo-clinical entity has been reported by Beasley et al. 2 as “acute fibrinous and organizing pneumonia (AFOP)”. The clinical spectrum of this entity may be similar to cryptogenic organising pneumonia and, taking into account the morphological features on surgical lung biopsy specimens, in our opinion, the case reported by Chee et al. 1 is more consistent with this diagnostic hypothesis.

Secondly, the diagnostic approach described in the paper by Chee et al. 1 is dissimilar to that usually followed in our centre (GB Morgagni Hospital, Azienda USL di Forlì, Forlì, Italy). In patients with alveolar opacification shadows, bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy may contribute to a definitive diagnosis in >60% of cases 3, 4, with fine-needle aspiration being less sensitive and specific 5.