SHM Converge Scientific Abstract ePoster Gallery-A Diagnostic Challenge: Cryptogenic Organizing Pneumonia in a Young Man With Multiple Sclerosis

Pdf Summary

This case describes a 39-year-old man with relapsing-remitting multiple sclerosis treated with ocrelizumab who developed one month of intermittent fevers, dry cough, chills, and diaphoresis. He also had a history of daily tobacco and marijuana vaping. Despite prior treatment for presumed multifocal pneumonia with broad-spectrum antibiotics, his symptoms and bilateral ground-glass opacities on chest CT worsened.<br /><br />An extensive infectious workup, including bacterial, fungal, mycobacterial, and viral studies, was negative. Bronchoscopy with BAL showed no malignancy and negative cultures. Lung biopsy revealed organizing pneumonia features, including Masson bodies, intra-alveolar fibrin, hyaline membrane-like changes, macrophages, and reactive pneumocytes. The final diagnosis was ocrelizumab-induced secondary organizing pneumonia, while EVALI remained an important diagnostic consideration because of the vaping history and overlapping clinical/histologic features.<br /><br />The patient was treated with systemic corticosteroids (prednisone), with marked radiographic improvement on follow-up CT six weeks later, though he developed localized left upper lobe fibrosis, a known complication of organizing pneumonia.<br /><br />Key teaching points are that organizing pneumonia should be considered in patients with persistent “pneumonia” that does not respond to antibiotics, anti-CD20 therapies such as ocrelizumab can cause secondary organizing pneumonia, and vaping history may complicate differentiation from EVALI. Clinical context, exposure history, imaging, and histopathology are essential for accurate diagnosis. Prognosis is generally favorable with steroid therapy, although residual fibrosis can occur.

Asset Subtitle

James M. Parra II

Meta Tag

Author List James M. Parra II, Michael A. Santos, Yusra Abu Shreikh

Category Clinical Vignettes

Concept Ocrelizumab

Concept Secondary Organizing Pneumonia

Concept Masson Bodies

Concept Pneumonia

Concept E-cigarette or Vaping-Associated Lung Injury

Distinguished Non-Finalist

Presenter Organization Brown University Health

Presenting Author James M. Parra II

Track Adult

Keywords

multiple sclerosis

ocrelizumab

organizing pneumonia

vaping

EVALI

ground-glass opacities

bronchoscopy

lung biopsy

corticosteroids

fibrosis

Ocrelizumab

Secondary Organizing Pneumonia

Masson Bodies

Pneumonia

E-cigarette or Vaping-Associated Lung Injury