Steroid refractory rapidly progressing organising pneumonia

Organising pneumonia (OP) is a lung inflammation-repair pattern characterised by rapid and complete resolution. In rare instances, it may progress to respiratory failure with poor outcomes due to steroid unresponsiveness and limited treatment options. A man in his 70s presented with shortness of breath, without accompanying symptoms, signs or laboratory markers of infection. Broad-spectrum antibiotics and corticosteroids were administered. An extensive infectious and immunological workup yielded negative results. Despite these interventions, the patient's oxygen requirements increased, necessitating invasive mechanical ventilation. OP was confirmed on biopsy. The patient's respiratory status did not improve and he was unable to be weaned from mechanical ventilation, ultimately resulting in death. This case prompted a review of the literature on rapidly progressive OP, a rare subset of steroid-refractory cases and treatments trialled by other authors. Alternative immunosuppressive treatments include mycophenolate, cyclosporine, rituximab and intravenous immunoglobulin but their use is limited to case reports and series.