A case report of Myelodysplastic Syndrome (MDS) involving Chromosomal Abnormality was associated with Acute Fibrinous and Organizing Pneumonia(AFOP)

Background: Acute fibrinous and organizing pneumonia (AFOP) is a rare form of acute lung injury characterized by intra-alveolar fibrin deposition, rather than the hyaline membranes seen in diffuse alveolar damage. While associated with various systemic conditions, its occurrence in patients with Myelodysplastic syndrome (MDS) is extremely rare and poses a significant diagnostic challenge due to its mimicry of infectious pneumonia. Here, we present a case where AFOP developed in an MDS patient, highlighting the diagnostic pitfalls and the potential role of an underlying genetic abnormality in triggering this specific pulmonary histological pattern. Case presentation:A 65-year-old woman with a history of MDS presented with progressive dyspnea and cough. Chromosomal analysis of her MDS revealed a complex karyotype: 46, XX, +1, der(1;21)(q10;q10), del(5)(q15;q35). She developed bilateral pulmonary consolidations that were unresponsive to broad-spectrum antimicrobial therapy. A CT-guided lung biopsy was crucial in excluding infection and establishing the diagnosis of AFOP based on the presence of intra-alveolar fibrin "balls" and organizing pneumonia. High-dose corticosteroid therapy resulted in significant clinical and radiographic improvement. However, the patient ultimately succumbed to the progression of her underlying MDS several months later. Conclusions: AFOP is a critical and treatable cause of non-infectious pulmonary consolidation in patients with hematologic dyscrasias like MDS. This case underscores the necessity for early tissue biopsy when pulmonary infiltrates fail to respond to antibiotics. The specific chromosomal abnormality observed, der(1;21), may be a key factor in predisposing MDS patients to this unique form of acute lung injury. Prompt recognition and corticosteroid therapy are vital to reverse respiratory failure, even if the long-term prognosis remains tied to the hematologic disease.