A43-19 Recurrent Spontaneous Pneumothorax in the Setting of Cryptogenic Organizing Pneumonia

Abstract Introduction Secondary spontaneous pneumothorax (SSP) is a commonly encountered clinical entity, whereby rupture or erosion of the visceral pleura allows air to leak into the pleural space. While SSP is frequently described in chronic obstructive pulmonary disease (COPD), infection, and interstitial lung disease, it is rarely reported in association with cryptogenic organizing pneumonia (COP). COP is an inflammatory lung disease characterized by alveolar injury that is typically responsive to corticosteroids. Here, we describe a case of recurrent SSP due to COP. Description The patient is a 50-year-old male with remote history of coccidioidal meningitis who presented to the hospital with sudden onset left-sided chest pain. A CT of the chest revealed a moderate left pneumothorax and several reticulonodular opacities, including one in the left lower lobe with a cavitary focus. A chest tube was placed with resolution of the pneumothorax, and the patient was referred for Infectious Diseases consultation given concern for pulmonary coccidioidomycosis. Cocci serologies returned negative, though suspicion remained given his history and residence in an endemic area (Southern Arizona). Roughly one year later, the patient was hospitalized with a left-sided pneumothorax. CT chest imaging showed multiple cavitary lesions throughout the lungs (Figure 1). He was referred for robotic navigation bronchoscopy and cryobiopsy of one of the cavitary nodules, which revealed focal organizing pneumonia. Infectious studies including tissue culture and bronchoalveolar lavage were unremarkable. Serologies for autoimmune disease including ANCA-associated vasculitis were negative. One month later, he again presented with a left-sided pneumothorax. CT chest showed resolution of the previously seen cavitary nodules and the development of a new cavity in the left upper lobe. Thoracic Surgery was consulted and performed a mechanical pleurodesis and pulmonary wedge resection of one of the cavities. Pathology noted multifocal, fibrosing organizing pneumonia. The patient was started on glucocorticoid treatment with resolution of previously seen cavitary lung disease and no further pneumothoraces to date. Discussion Cryptogenic organizing pneumonia is a rare cause of cavitary lung disease and has only been reported a handful of times in literature as a cause of pneumothorax, as in this case. Establishing a diagnosis was challenging and protracted, particularly given suspicion for pulmonary coccidioidomycosis, both because of the patient’s history of disseminated infection and the high incidence where the patient lived. This case also highlights the use of transbronchial lung cryobiopsy (TBLC) to establish a diagnosis, a technique increasingly used in the evaluation of interstitial lung diseases. This abstract is funded by: None