[A patient with cryptogenic organizing pneumonitis who presented with multiple patchy shadows]

A 62-year-old woman was admitted to our institution for abnormal shadows on a screening chest roentgenogram. An immunoelectrophoresis test on admission revealed a polyclonal gammopathy. In her bronchoalveolar lavage fluid, the percentage of lymphocytes was found to be high: 47%. These results indicated an abnormal immunological state. A chest X-ray film showed multiple patchy shadows in both lungs. A chest CT scan revealed that the shadows were distributed peripherally, and abutted the pleura. Before treatment, the lesions enlarged toward the hilum concentrically, and cleared from the pleural side. This change is characteristic of cryptogenic organizing pneumonitis. The pathological finding at open lung biopsy was organizing pneumonitis. Bronchiolitis obliterans was not pathologically recognized. The shadows on the chest X-ray film almost completely disappeared after treatment with predonisolone at a daily dose of 30 mg. We diagnosed this as a case of cryptogenic organizing pneumonitis with typical shadows.