Title : Organizing pneumonia from chronic aspiration: A lung tumor mimicker
Abstract:
Background of the study: Chronic aspiration is common in patients with uncontrolled gastrosophageal reflux disease (GERD). Aspiration can cause recurrent pneumonia, chemical pneumonitis, and in rare cases, organizing pneumonia. Head and neck tumors needing high dose radiation therapy can cause radiation injury to the vocal cords leading to chronic aspiration.
Case Summary: A 65-year old American male, residing in the Philippines, with a 20-pack year smoking history was diagnosed with tongue cancer and treated with high dose radiation and chemotherapy for more than ten years prior to admission. He has a 4-year history of recurrent episodes of pneumonia due to chronic uncontrolled GERD and subsequently underwent Nissen fundoplication. Patient was referred to our institution for non-resolving pneumonia associated with hypoxemia,dyspnea on exertion, and chronic nonproductive cough. A positron emission tomography (PET) scan revealed heterogeneously enhancing soft tissue densities in the inferior lingula and posterolateral left lower lobe, the largest of which measures 2.1x1.9cm with fluorodeoxyglucose uptake (SUVs up to 8.6) suggestive of a neoplastic and metastatic process.
Computed tomography-guided biopsy showed moderate chronic interstitial inflammation with organizing pneumonia and foreign body type multinucleated giant cells with some sections showing food particles. Fiberoptic endoscopic evaluation of swallowing (FEES) was also done which showed micro-penetration with thin liquid boluses with resolution from chin-tuck swallowing therapy. Patient was treated with broad-spectrum antibiotics and steroids. He was discharged well with decreasing oxygen requirement and was maintained on oral steroids which was gradually tapered.
Follow-up CT scan showed significant reduction in size of the lung mass. The patient had two further episodes of pneumonia post-discharge, thus, the decision for a redo fundoplication with gastrostomy tube insertion was made.
