The dose of azathioprine was not increased above 150 mg/day, and the cytotoxic drug was stopped, due to persistent exacerbations and hospital admission. The patient started high dose of corticosteroid therapy (equivalent dose of prednisolone 1 mg/Kg/day), but as there was no clinical improvement and tapering glucocorticoid therapy was not possible, four months later, azathioprine was added. The diagnosis of COP was established, since no aetiology related to OP was found. The patient was then referred for pulmonology consultation and a second transthoracic core biopsy was performed revealing features compatible with OP, namely chronic inflammation and intra-alveolar organizing fibromyxoid polyps ( Fig. In the meanwhile, there was clinical deterioration with the patient presenting a moderate obstructive ventilatory syndrome (FEV1 = 53%) without bronchodilator reversibility, slight hipoxemia (Pa02 = 71.5 mmHg) and significant desaturation in the six minute walk test (S02 = 90-95%, 500m). Transthoracic core biopsy was inconclusive. Autoimmunity and serologic blood studies did not point to any specific etiology. No microbiological agents or evidence of malignancy were found. Bronchoalveolar lavage (BAL) performed during one hospital admission, revealed neutrophilia (12.8%) and a slight eosinophilia (2.2%) there was no lymphocytosis (13.6%). During these episodes, chest high resolution computed tomography (HRCT) showed peripheral and migratory multifocal consolidations with air bronchogram and a ground glass pattern, sometimes without being completely resolved between crises ( Fig. In the previous five years, as well as chronic treatment with a long acting bronchodilator and corticosteroid (salmeterol 50/fluticasona 250 μg), she had had multiple courses of systemic corticosteroids and antibiotics due to respiratory exacerbations consisting of fever, wheeze, dyspnea and sometimes pleuritic chest pain. She had never smoked and worked as financial administrator. Case reportĪ sixty-year-old female with a controlled intrinsic bronchial asthma (intermittent), diagnosed in childhood, presented with recurrent pneumonias which had led to multiple hospital admissions. A brief review on the literature data about the anti-inflammatory effects of macrolides in chronic airway diseases is included. The authors report a case of a sixty-year-old woman, with controlled intrinsic bronchial asthma, who presented COP and several respiratory exacerbations despite corticosteroid and immunossupressant therapy, being successfully treated with azithromycin as an adjuvant to steroids. 2,3 There are, however, some reports of patients responding to the immunomodulatory properties of chronic low dose therapy with macrolides, providing an alternative in patients with mild disease or for those who cannot tolerate steroids or as adjuvant to standard treatment. 1Corticosteroids are the first line therapy in the majority of patients, these are usually effective and lead to a good prognosis. The term COP is used when the disease is idiopathic. 1 The histological pattern is that of organizing pneumonia (OP), which can be seen in a wide variety of settings. A azitromicina foi mantida (3 vezes/semana) sem documentação de efeitos laterais adversos.Įste caso clínico reforça o potencial papel das propriedades anti-inflamatórias dos macrólidos na COP, como terapêutica adjuvante dos corticoesteróides.Ĭryptogenic organising pneumonia (COP) is an inflammatory disease that mainly affects the alveolar airspaces, ducts and small airways, although the interstitium can also be involved. A suspensão dos corticoesteróides foi possível no período de um ano, sem evidência de recidiva nos seis meses seguintes.
Após início de azitromicina (500 mg, dias alternados), como adjuvante da corticoterapia, verificou-se melhoria clínica e funcional e regressão dos infiltrados pulmonares.
Os autores descrevem o caso de uma mulher de 60 anos de idade, com asma intrínseca controlada, que apresentou uma COP e exacerbações respiratórias de repetição, apesar da corticoterapia e terapêutica imunossupressora instituídas. Existem dados na literatura sobre o uso das propriedades imunomoduladoras de alguns macrólidos no tratamento da pneumonia organizativa criptogénica (COP) como alternativa aos corticoesteróides na doença ligeira ou como adjuvantes da terapêutica padrão.
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