Organizing pneumonia: what is the culprit?

SESSION TITLE: Diffuse Lung Disease Case Report Posters 12 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Organizing pneumonia (OP) can be idiopathic or secondary to aspiration, drugs, rheumatologic diseases, or infections. We identified 3 patients who developed OP 1-2 weeks after SARS-CoV-2 mRNA vaccination. CASE PRESENTATION: Patient 1: A 66-year-old, male former smoker presented with fever, dry cough, and progressive hypoxemia 2 weeks after his first dose of an mRNA vaccine (Pfizer). He was hospitalized, had a chest CT which showed bilateral ground-glass opacities (GGOs) and peripheral consolidations, and was treated with antibiotics and high-dose corticosteroids. His infectious and rheumatologic workup was unrevealing, and his hypoxemia progressed with attempts to wean corticosteroids. He was transferred to our center for further workup and a lung transplant (LT) evaluation and had a transbronchial cryobiopsy which confirmed OP with features of cicatricial variant, chronic bronchiolitis, peribronchial metaplasia, and mild focal interstitial fibrosis. Corticosteroids were slowly tapered, and he was listed for LT given persistent high oxygen requirements. However, follow-up revealed clinical and radiographic improvement, which prompted delisting. He is now on long-term low-dose corticosteroids with minimal supplemental oxygen requirements.Patient 2: A 47-year-old, male former smoker, with a family history of pulmonary fibrosis, developed low-grade fevers, dry cough, and dyspnea, one week after his first mRNA vaccine (Moderna). Chest CT revealed extensive bilateral consolidation along with subpleural foci of GGOs. His rheumatologic workup was negative, and his infectious workup was notable only for positive Mycoplasma pneumoniae IgG, but negative IgM. Bronchoalveolar lavage showed no diffuse alveolar hemorrhage or eosinophilia, and transbronchial biopsy confirmed OP. His symptoms initially improved with corticosteroids, and he received 1 additional mRNA vaccine dose that correlated to worsening of disease. His symptoms and radiographic abnormalities return when corticosteroids are tapered and he remains corticosteroid-dependent today.Patient 3: A 61-year-old man with a history of coronary artery bypass graft, aortic valve replacement, and recent diagnosis of idiopathic pulmonary fibrosis presented 12 days after his second mRNA vaccine (Pfizer) with fever, chills, dyspnea, and hypoxia. His chest CT revealed traction bronchiectasis, upper lobe predominant infiltrates, and GGOs. He underwent an open right lung biopsy, which confirmed OP. He progressed to hypoxemic respiratory failure, requiring intubation, venovenous extracorporeal membrane oxygenation support, and bilateral LT 42 days after initial symptom onset. DISCUSSION: Although clinical trials have confirmed the safety and efficacy of mRNA vaccines, rare adverse events occur. We report 3 cases of respiratory failure due to OP shortly after vaccination. CONCLUSIONS: Although a definitive causal relationship cannot be established, SARS-CoV-2 mRNA vaccination was temporally associated with the development of severe OP in 3 patients. REFERENCE #1: Cordier JF. Cryptogenic organizing pneumonia. Eur Respir J. 2006;28(2):422-446. REFERENCE #2: Park JY, Kim J, Lee IJ, et al. COVID-19 vaccine-related interstitial lung disease: a case study. Thorax 2022;77:102-104. REFERENCE #3: Watanabe S, Waseda Y, Takato H, et al. Influenza vaccine-induced interstitial lung disease. Eur Respir J. 2013;41(2):474-477. DISCLOSURES: No relevant relationships by Bhuvin Buddhdev No relevant relationships by Devika Sindu No relevant relationships by Sofya Tokman Speaker/Speaker's Bureau relationship with Astellas Please note: 2016 to present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer INgelheim Please note: 2016-present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Takeda Please note: 2018-present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Honoraria Principal Investigator relationship with Grifols Please note: 2015- present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Grant/Research Support Advisory Committee Member relationship with Transmedics Please note: 2021 Added 12/04/2022 by Rajat Walia, source=Web Response, value=Consulting fee Advisory Committee Member relationship with CareDx Please note: 2020-present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Consulting fee