AFOP 作为一种组织学类型,已获得了美国胸科学会和欧洲呼吸学会的认可。目前关于 AFOP 是否为 ILD 的独立病理类型尚存在争议,有人认为 AFOP 是 DAD 或者 OP 病程中的一个变异类型,也有人认为它是特发性的 ILD[4]。在某些情况下,可以表现为特发性的病例,即使经过细致的临床检查,也找不出任何相关的危险因素。但它也可在以下不同的疾病中观察到,如过敏性肺炎、感染、肺部药物毒性、血液系统恶性肿瘤以及结缔组织病等[5-7]。就如本例患者,既往有类风湿病史,近期才出现肺部病灶,且患者 ANA 谱阳性(抗核抗体 S 型 1∶6 400),在鉴别诊断时需要与类风湿性关节炎相关性间质性肺疾病、ANCA 相关性血管炎肺部表现相鉴别。
Beasley MB, Franks TJ, Galvin JR, et al. Acute fibrinous and organizing pneumonia: a histological pattern of lung injury and possible variant of diffuse alveolar damage. Arch Pathol Lab Med, 2002, 126(9): 1064-1070.
Fasanya A, Gandhi V, DiCarlo C, et al. Acute fibrinous and organizing pneumonia in a patient with Sjogren’s syndrome. Respir Med Case Rep, 2017, 20: 28-30.
4.
Travis WD, Costabel U, Hansell DM, et al. ATS/ERS Committee on Idiopathic Interstitial Pneumonias. An official American Thoracic Society/European Respiratory Society statement:update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2013, 188(6): 733-748.
5.
Lococo1 F, Rossi G, Filice A, et al. A Woman with progressive dyspnea and multiple lung consolidative lesions. Am J Respir Crit Care Med, 2014, 190(6): e22-e23.
Hariri LP, Unizony S, Stone J, et al. Acute fibrinous and organizing pneumonia in systemic lupus erythematosus: a case report and review of the literature. Pathol Int, 2010, 60(11):755-759.
8.
Kuz C, Matheos T, Kathman D, et al. Life after acute fibrinous and organizing pneumonia: a case report of a patient 30 months after diagnosis and review of the literature. J Crit Care, 2016, 31(1): 255-261.
9.
Kligerman SJ, Franks TJ, Galvin JR. From the radiologic pathology archives: Organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia. Radiographics, 2013, 33(7):1951-1975.
Aktar A, UI Abideen Z. Acute fibrinous and organizing pneumonia masquerading as a lower respiratory tract infection: a case report and review of the literature. BMC Res Notes, 2015, 8:38-43.