A 64-year-old woman, ex-smoker of 20 paq/year, with a history of chronic arterial hypertension treated with losartan 50 mg/day, with tangential partial radiation therapy Gyva 50 Gymnastics with partial
One month after the end of radiotherapy, the patient complained of general malaise, decay, irritative cough with low purulent secretion, dyspnea on moderate exertion, bilateral dorsal pain, and intermittent fever quantified at 37.7°C of auscultation.
His complete blood count showed mild normochromic normocytic anemia (hematocrit 31%) and erythrocyte sedimentation rate (HSV) 140 mm/h.
The chest X-ray complemented with a chest computed tomography (CT) showed extensive foci of condensation in the left upper lobe and in the right middle and lower lobes.
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Microbiological tests (Gram and sputum culture, haemocultives and viral panel) were negative except serum immunoglobulin M measurement for Mycoplasma pneumoniae and persisted for 10 days following treatment with levofloxacin 500 mg.
A new CT scan performed two and a half months after the first showed partial resolution of the pulmonary infiltrates with new foci of condensation.
The immunological study with antinuclear antibodies and anti DNA, ENA profile and rheumatoid factor were normal.
In his lung function tests stood out a normal void residual urine test (a diffusion capacity of carbon monoxide corrected by hemoglobin (DLCODRc) of 14.8 mL/min/mmHg (corresponding to 90% alveolar pulse).
The clinical picture was consistent with bronchoalveolar lavage (BAL) and transbronchial biopsies were performed 10 days after the last CT.
Quantitative aerobic microbiological cultures of Koch and BAL fluid were negative.
BAL differential cell count showed 90% macrophages, 6% lymphocytes, 3% neutrophils and less than 1% eosinophils.
Transbronchial biopsy showed focal interstitial pneumonia with lax alveolar plugs and interstitial lymphocytic infiltrate, compatible with the diagnosis of OP.
Steroid treatment was started with prednisone 0.6 mg/kg/day with gradual progressive decrease within one year.
At the fourth month of treatment she had complete resolution of clinical signs and symptoms, radiographic changes, complete blood count findings and normalization of pulmonary function tests, with a theoretical DLCOc of 16.6 mL/min VA/mmHg (84.40%).
