Cryptogenic Organizing Pneumonia: A Misdiagnosis or Missed Diagnosis in Resource –Poor Settings: A Case Report and Literature Review.

Background: Cryptogenic organising pneumonia (COP) is a diagnosis made by a combination of clinical, radiological and histology features; after ruling out other causes of organizing pneumonia. There is no consensus on prevalence. COP is often missed or widely misdiagnosed and under-reported in resource-poor settings (like Nigeria); where diagnostic modalities such as Chest CT (computed tomography) scan and lung biopsy are not readily available. Most febrile patients who present with cough and have opacities or infiltrate on chest radiograph, are diagnosed as pneumonia (from infective causes) and treated with antimicrobial agent for prolonged periods, despite persistent of symptoms. Case Presentation: A 57-year-old male who was referred to the Pulmonologist for specialist evaluation for persistence of chronic cough, dyspnoea, weight loss and other constitutional symptoms despites prolong use of antibiotics. Chest examination revealed reduced breath sounds on the both lower lung zone and crackles on left mid and both lower lung zones posteriorly. Chest radiography showed consolidation. He was given several courses of antibiotic therapy with no resolution prior to referral. Chest CT scan done was highly suggestive of Cryptogenic Organising pneumonia (COP), which was confirmed by histology of a trans-bronchial biopsy. Result: Patient’s symptoms abated within 72 hours of steroid administration. Conclusion: This case report demonstrates the delay in early diagnosis of COP, where confirmatory diagnostic procedures are limited. Furthermore, it shows the prolonged/inappropriate use of antibiotic in such cases without resolution.