Cryptogenic Organizing Pneumonia and Steroids

The Bottom Line: Cryptogenic organizing pneumonia has been reported to respond to corticosteroids with clinico-radiographic resolution in 70-80% of cases. Treatment duration is lengthy, and despite this, recurrences and late recurrences are common.

Presumed Dx: Renal-pulmonary syndrome.

Clinical Question: What is the frequency of response of cryptogenic organizing pneumonia to steroids?

Article: Schlesinger C, Koss MN.  The organizing pneumonias: an update and review.  Curr Opin Pulm Med. 2005 Sep;11(5):422-30.

Summary: Cryptogenic organizing pneumonia has been reported to respond to corticosteroids with clinico-radiographic resolution in 70-80% of cases. Treatment duration is lengthy, and despite this, recurrences and late recurrences are common. Rapidly progressive, steroid resistant and poor prognostic forms of organizing pneumonia have been described and have been reported more frequently with secondary organizing pneumonia. Since other histologic interstitial patterns often coexist with organizing pneumonia, tissue sampling error or an incorrect morphologic diagnosis can be the reason for aggressive clinical behavior. Steroid nonresponsive patients have been treated with secondary non-steroidal agents. Good clinical outcomes have been reported.

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