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Mysterious changes in the lungs: Why are symptoms of COP often misdiagnosed as infection?
Cryptogenic organizing pneumonia (COP), formerly bronchiolitis obstructive pulmonary disease (BOOP), is a traumatic disease of the lungs. Usually, it is caused by chronic inflammatory diseases of the lungs such as rheumatoid arthritis, dermatomyositis, etc. It may also be a side effect of certain drugs, such as amiodarone. This disease was first described by Gary Epler in 1985. It shows clinical and imaging features similar to those of infectious pneumonia. Its diagnosis is often doubted because it does not respond to multiple antibiotics, which makes the misdiagnosis rate quite high.
"The classic manifestations of COP are non-specific systemic and respiratory symptoms, often mistaken for infection."
It is reported that symptoms of COP patients usually manifest over a period of weeks to months, with dry cough, dyspnea and fever being the most common symptoms. The presence of these symptoms often means that the patient has received at least one failed antibiotic treatment before a true diagnosis is obtained. This makes it more challenging for medical professionals to obtain a diagnosis.
Symptoms and causes of misdiagnosis
The clinical manifestations of COP include fever, chills, night sweats, fatigue and weight loss. These non-specific systemic symptoms often cause doctors to misdiagnose the condition as infection. According to statistics, 71% of patients had dry cough, 62% felt difficulty breathing, and 44% had fever.
"Many COP patients have received multiple antibiotic treatments because of suspected pneumonia before diagnosis."
Causes and risk factors of COP
COP has multiple causes, including lung infections caused by bacteria, viruses and parasites, as well as exposure to certain drugs and chemicals. Certain anti-tumor drugs, diacetyl, and e-cigarettes can all cause this condition. Studies have pointed out that patients with inflammatory diseases such as rheumatism, dermatomyositis, rheumatoid arthritis, and scleroderma usually face a higher risk of COP.
Pathophysiology
Histologically, COP is mainly preceded by some kind of damage to the lungs, which damages the epithelial basement membrane of the alveolar walls, leading to the infiltration of inflammatory cells into the alveoli. During this process, fibroblasts also begin to proliferate and gradually form tiny fibrous structures, which is a characteristic of COP. This pathological change differs from usual interstitial pneumonia, which results in extensive fibrosis and significant damage to lung structures.
Diagnostic and Imaging Technology
During clinical examination, doctors often find chirping sounds in patients through auscultation. In laboratory tests, certain inflammatory markers such as erythrocyte sedimentation rate or C-reactive protein levels tend to rise. Results may show a nonspecific inflammatory response. However, with chest X-rays and planar chest CT imaging, doctors can observe typical features, such as white patches in the lungs that move and spread.
"Chest X-ray can show a large amount of alveolar filling, and CT examination can further confirm the diagnosis of COP."
Treatment methods
For the treatment of COP, the use of systemic steroids is considered the first choice, and many patients experience clinical improvement within 72 hours of starting treatment. It is generally recommended that treatment last for 4 to 6 months, and if necessary, prevent pulmonary cyst pneumonia in patients using larger doses of steroids.
Conclusion
In summary, COP easily falls into the trap of clinical misdiagnosis due to its confusing symptoms and characteristics. In the future, is it necessary for the medical community to strengthen the understanding and diagnosis of COP to reduce the misdiagnosis rate?
