Acute Fibrinous and Organizing Pneumonia (AFOP) in Children: A Case Report and Literature Review

Mohammed AlZaid,1 Ahmed AlEidan,2 Wajd AlThakfi,3 Wadha Helal Alotaibi1 1Paediatric Pulmonology and Sleep Medicine Department, Children’s Specialised Hospital, King Fahad Medical City, Riyadh, Saudi Arabia; 2Paediatric Pulmonology Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia; 3Histopathology Unit and Pathology Department, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi ArabiaCorrespondence: Ahmed AlEidan, Paediatric Pulmonology Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia, Email [email protected]: Acute Fibrinous and Organizing Pneumonia (AFOP) is a rare lung disease that presents with acute lung injury characterized by intra-alveolar fibrin deposition. Although primarily described in adults, AFOP can occur in children and may mimic common respiratory illnesses, posing a diagnostic challenge. The condition can result from various etiological factors, including infections, autoimmune disorders, and drug reactions. The purpose of this case is to highlight the clinical presentation, diagnostic challenges and management strategies of this rare and underrecognized pediatric condition. By describing this case we aim to raise awareness among pediatricians given the limited literature on pediatric AFOP to aid in recognizing and tailoring treatment in order to improve outcomes.Methods and Materials: Patient’s data were collected retrospectively from medical records, including clinical notes, laboratory results, imaging studies, and histopathological findings, where applicable. Informed written consent was obtained and signed from parents of the child for the use of his medical information for educational and publication purposes, ensuring confidentiality and anonymity.Results: We present the case of a 3-year-old boy with a history of recurrent viral-induced wheezing, initially treated for asthma-like symptoms until he developed persistent hypoxemia. Despite targeted therapy, the patient exhibited persistent respiratory symptoms and consolidative opacities in the right lung. A high-resolution computed tomography (HRCT) scan showed diffuse lung abnormalities, prompting further evaluation. Bronchoscopy with bronchoalveolar lavage revealed Haemophilus influenzae infection, and an open lung biopsy confirmed AFOP. The patient was treated with corticosteroids and azithromycin, leading to significant clinical and radiographic improvement.Conclusion: This case highlights the importance of considering AFOP in pediatric patients with atypical and persistent respiratory symptoms. Early diagnosis and intervention are crucial for managing this rare condition. Further case reports are needed to better understand AFOP’s clinical course and optimize treatment strategies in pediatric populations.Keywords: acute fibrinous and organizing pneumonia, pediatric