(1192) A Unique Case of Cryptogenic Organizing Pneumonia in a Young Adult Male

Introduction: Cryptogenic Organizing Pneumonia (COP) is a relatively rare condition, particularly in young adult males. It's more prevalent in adults aged 50 to 70 and is characterized by inflammation and scarring in the lung tissue. I am presenting a unique case of a young adult male presenting with persistent cough and new hypoxia, with no risk factors for developing COP. Given the rarity of COP in young adults, it highlights the importance of comprehensive evaluation and careful consideration of all possible contributing factors. Seeking early medical attention from a pulmonologist is crucial in facilitating a prompt and accurate diagnosis, leading to appropriate treatment and an improved prognosis.

Description: The patient is a 35-year-old male with an unremarkable medical history, who presented with a 3-week history of dyspnea and non-productive cough. Despite receiving treatments for bronchitis and pneumonia on separate occasions, there was no improvement in his symptoms. Vitals were unremarkable aside from sinus tachycardia 101 and SpO2 92% on 3L NC. CTA PE chest revealed diffuse miliary opacities, prompting evaluation for infectious and autoimmune etiologies. Notably, testing for tuberculosis, histoplasma, Blastomyces, aspergillus, ANCA, CCP, RF, and HIV all returned negative results. Empiric therapy with Cefepime, Doxycycline, Itraconazole, and Prednisone was initiated. A bronchoscopy was performed, but post-procedure, the patient's respiratory distress worsened, necessitating intubation. Subsequently, bronchoscopic pathology revealed cryptogenic organizing pneumonia, characterized by fibrosis, acute and chronic inflammation, and granulation tissue. Steroid therapy was initiated, and antibiotics and antifungals were stopped, resulting in a significant improvement in the patient's overall status.

Discussion: While Cryptogenic Organizing Pneumonia is rare in young adults, vigilant management is crucial for favorable outcomes. Early detection and treatment are paramount, given its infrequency in this age group. Limited reported cases in the literature highlight the need for further research to understand this unique presentation. Healthcare professionals must exercise diligence when evaluating young adults with respiratory symptoms, as prompt intervention can improve prognosis and care quality.