Cryptogenic Organizing pneumonia (COP)

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Summary 1) Wikipedia

Cryptogenic Organizing pneumonia (COP) or Bronchiolitis obliterans organizing pneumonia (BOOP) is a non-infectious pneumonia; specifically, an inflammation of the bronchioles (bronchiolitis) and surrounding tissue in the lungs.

Pathophysiology 2) European Respiratory Journal

Bilateral ill-defined nodular opacities (Radiopaedia)

In COP, aAlveolar epithelial injury is the first event, with necrosis and sloughing of pneumocytes resulting in the denudation of the epithelial basal laminae. Most basal laminae are not destroyed, although some gaps are present. The endothelial cells are only mildly damaged. In contrast with diffuse alveolar damage, no hyaline membranes are found. Inflammatory cells (lymphocytes, neutrophils, some eosinophils) infiltrate the alveolar interstitium. Fibroblasts present in the interstitium exhibit features of activation, such as conspicuous rough endoplasmic reticulum and Golgi apparatus, but these are not increased in number and there are no associated collagen deposits.

Causes 3) Wikipedia

  • Pulmonary infection – bacteria, viruses and parasites 
  • Drugs – antineoplastic drugs, erlotinib 
  • Toxic fumes 
  • Ionizing radiations 
  • Inflammatory diseases – systemic lupus, rheumatoid arthritis (RA-associated BOOP), scleroderma 
  • Bronchial obstruction – Proximal bronchial squamous cell carcinoma

Alveolar duct filled with immature connective tissue, fibroblasts, and inflammatory cells (Wikipedia)

Symptoms 4) Wikipedia

  • Nonspecific systemic – fevers, chills, night sweats, fatigue, weight loss 
  • Respiratory – dyspnea, cough

Diagnosis 5) Robbins Basic Pathology by Vinay Kumar

  • Chest X-ray – subpleural or peribronchial patchy areas of air space consolidation 
  • Pathology – presence of polypoid plugs of loose organizing connective tissue within alveolar ducts, alveoli, and often bronchioles

Treatment 6) Wikipedia

  • Corticosteroid therapy  prednisolone, prednisone

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