Chest
Volume 102, Issue 3, September 1992, Pages 715-719
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Clinical Investigations
Bronchiolitis Obliterans Organizing Pneumonia: Clinical Features and Differential Diagnosis

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The clinical features of 34 Japanese patients with bronchiolitis obliterans organizing pneumonia (BOOP) are discussed. Thirty-two patients (94 percent) had symptoms of cough, fever, or dyspnea. On chest roentgenograms, bilateral patchy infiltrates were seen most frequently in 23 patients (68 percent), followed by small linear opacities in five (15 percent), both patchy infiltrates and reticulonodular opacities in four (12 percent), and reticulonodular opacities in two (6 percent). The bronchoalveolar lavage fluid (BALF) cell findings obtained from 26 patients revealed an increase in the percentage of lymphocytes in 20 patients (77 percent), neutrophils in 15 (58 percent), and eosinophils in 16 (62 percent), and a decrease in the CD4+/CD8+ ratio in 14 of 23 patients (61 percent). Corticosteroids were administered to 25 patients. Except for one patient who died, the prognosis was good in all patients. Further, in patients without corticosteroid therapy, the prognosis was good.

Section snippets

Patients and Materials

During a BOOP meeting held in Kyoto, Japan (1990), clinical data, chest roentgenographic and CT films, and pathologic materials obtained from patients diagnosed as having BOOP or being suspected of having BOOP by open lung biopsy, collected all over Japan, were discussed. Cases histopathologically diagnosed as BOOP according to Dr. Thomas V. Colby2 with unknown causes and not associated with other diseases were analyzed. Furthermore, the clinical features of 15 open lung biopsy specimens from

Clinical Data

There was no sexual predominance (Table 1), the incidence being similar between men and women. The mean age of the patients was in the mid 50s. Fifty-six percent of patients were nonsmokers, and 44 percent had a smoking history. There was no correlation between smoking status and BOOP.

Initial symptoms were cough (76 percent), fever (53 percent), and dyspnea (47 percent), and 94 percent of the patients had one, two, or all of these symptoms.

Crackles were heard at a high rate (79 percent),

Discussion

The clinical features of 34 Japanese patients with BOOP have been reported. These clinical findings are in agreement with those reported previously,3, 4, 5, 6, 7 and they are considered to be useful in the diagnosis of BOOP The diagnosis of BOOP has relied upon open lung biopsy, but the clinical diagnosis for management can be made when the case shows the above clinical features, and in which transbronchial lung biopsy has revealed the findings of proliferative bronchiolitis obliterans and

ACKNOWLEDGMENT

This report is a joint study of the following hospitals in Japan: Sapporo Medical College Hospital, Sapporo Horonan Hospital, Akita University Hospital, JR Tokyo General Hospital, Tokyo Antituberculosis Association Hospital, Tokai University Hospital, Hamamatsu Medical College Hospital. Hamamatsu Medical Center, Seirei Mikatagahara Hospital. Aichi Medical College Hospital, Fukui Red Cross Hospital, Shiga Medical College Hospital, Chest Disease Research Institute Hospital of Kyoto University,

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