Frontiers in Medicine · Published 2026-08-17 · Journal article · DOI 10.3389/fmed.2026.1901693
Qiang-zhong Pi, Min Wu, Hu Luo
BackgroundAcute fibrinous and organizing pneumonia (AFOP) is a rare and distinct histopathological pattern of acute lung injury characterized by intra-alveolar fibrin deposition. It poses significant diagnostic and therapeutic challenges due to its heterogeneous etiologies and the lack of standardized clinical guidelines.Case presentation and methodsWe report the clinical course of a 58-year-old male presenting with Aspergillus fumigatus-associated AFOP complicated by spontaneous subcutaneous and mediastinal emphysema. Diagnosis was confirmed via CT-guided percutaneous lung biopsy. Additionally, we conducted a systematic literature review of PubMed and EMBASE databases (January 2019 to July 2024) to analyze the clinical-radiological features, etiological spectrum, and treatment outcomes of 31 unique AFOP cases.ResultsThe case patient presented with fever, chest pain, and dyspnea. Following confirmation of A. fumigatus-induced AFOP and management of secondary mediastinal emphysema via negative-pressure closed thoracic drainage, the patient showed a favorable response to combined corticosteroid and antifungal therapy. The literature review of 31 patients revealed a male predominance (17/31, 54.8%) with a mean age of 55 ± 15 years (range: 22–78). Fever was the most prevalent clinical presentation (23/31, 74.2%), followed by cough (19/31, 61.3%) and dyspnea (13/31, 41.9%). Chest computed tomography (CT) predominantly revealed consolidation (22/31, 71.0%) and ground-glass opacities (12/31, 38.7%). Identified etiologies were highly heterogeneous, including idiopathic forms, infections, hematologic malignancies, and autoimmune disorders. Glucocorticoid-based regimens achieved an overall treatment response rate exceeding 73%.ConclusionAFOP is a multifaceted pulmonary disorder associated with non-specific symptoms and radiological features like consolidation and ground-glass opacities. Aspergillus infection can trigger AFOP, which may be rarely complicated by spontaneous mediastinal emphysema. Early histopathological confirmation and individualized immunomodulatory therapy are crucial for favorable clinical outcomes.LimitationsThis study is limited by a small literature cohort size, a lack of multivariable analysis, and limited molecular epidemiological data.
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Pi, Q., Wu, M., Luo, H. (2026). Aspergillus fumigatus-induced acute fibrinous and organizing pneumonia complicated by spontaneous subcutaneous and mediastinal emphysema: a case report and literature review. Frontiers in Medicine. https://doi.org/10.3389/fmed.2026.1901693