Irfan M, Zubairi ABS, Husain S J.
Bronchiolitis Obliterans organizing Pneumonia associated with Cytomegalovirus infection in a patient with Systemic Lupus Erythematosus.
J Pak Med Assoc Jan ;54(6):328-30.

A 48 year-old man, non-smoker, presented with a 15-day history of fever, dry cough and progressively increasing shortness of breath. He had been diagnosed as a case of Systemic lupus erythematosus (SLE) with lupus nephritis 6 months ago and was on maintenance dose of Prednisolone (10-mg/day) and Cyclophosphamide (50-mg/day). Before presenting to us he had already taken 2 courses of broad-spectrum antibiotics. Physical examination revealed tachypnea, fever (temperature 38°C) and diffuse bilateral end-inspiratory crackles on chest auscultation. Laboratory studies showed the following values: Hemoglobin 10.3g/dl; WBC count 10,100/cmm3. Arterial blood gases revealed pH, 7.48; PaCO2 36.2 mmHg and Pa02 63.3mmHg. A chest roentgenogram showed bilateral alveolar infiltrates denser in the lower zones. A high resolution CT chest also confirmed chest X-ray findings. Bronchoscopy was unremarkable. Bronchoalveolar lavage was negative for any microorganism. Blood cultures were also negative. He was started on imipenem and diflucan, along with 100mg of hydrocortisone every 6 hours, but his symptoms worsened over the next 3 days and Subsequently open lung biopsy was performed. Histological analysis of a biopsy specimen showed the presence of extensive patchy changes characterized by plugging of bronchioles with polypoidal fibroblasts mixed with fibrinous exudates and organization, extending into alveolar ducts and peribronchiolar alveolar spaces. The features were consistent with BOOP.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com