A RARE CASE REPORT OF CRYPTOGENIC ORGANIZING PNEUMONIA WITH HAEMORRHAGIC PLEURAL EFFUSION

Cryptogenic organizing pneumonia (COP) is a rare idiopathic interstitial lung disease characterized by granulation tissue proliferation within the distal airways and alveolar ducts, often misdiagnosed as community-acquired pneumonia (CAP) due to overlapping clinical and radiological features. We present a case of a 32-year-old male with subacute symptoms of fever, cough, and progressive dyspnea unresponsive to antibiotics. Initial investigations revealed elevated inflammatory markers, consolidation on chest radiograph, and negative infectious and autoimmune screening. Despite empirical antibiotic therapy, the patient showed no clinical improvement. High-resolution computed tomography (HRCT) demonstrated patchy peripheral consolidations and ground-glass opacities. Bronchoalveolar lavage (BAL) showed mixed inflammatory cells, and transbronchial lung biopsy confirmed the diagnosis by revealing intra-alveolar fibroblastic plugs (Masson bodies). Notably, the patient developed hemorrhagic pleural effusion—an uncommon and atypical feature of COP. Corticosteroid therapy with oral prednisolone led to significant clinical and radiological improvement. This case underscores the importance of considering COP in non-resolving pneumonia, particularly when imaging and clinical findings deviate from typical infectious etiologies. Early recognition and corticosteroid therapy are crucial for favorable outcomes. Atypical presentations, such as hemorrhagic pleural effusion, warrant careful evaluation to rule out alternative diagnoses and emphasize the variable spectrum of COP manifestations.