{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T06:24:12Z","timestamp":1786947852523,"version":"build-2736575974"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation and methods<\/jats:title>\n                    <jats:p>\n                      We report the clinical course of a 58-year-old male presenting with\n                      <jats:italic>Aspergillus fumigatus<\/jats:italic>\n                      -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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The case patient presented with fever, chest pain, and dyspnea. Following confirmation of\n                      <jats:italic>A. fumigatus<\/jats:italic>\n                      -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\u202f\u00b1\u202f15 years (range: 22\u201378). 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%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AFOP 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>This study is limited by a small literature cohort size, a lack of multivariable analysis, and limited molecular epidemiological data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1901693","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:25:14Z","timestamp":1786944314000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Aspergillus fumigatus-induced acute fibrinous and organizing pneumonia complicated by spontaneous subcutaneous and mediastinal emphysema: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Qiang-zhong","family":"Pi","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Army Medical University (Southwest Hospital)","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Wu","sequence":"additional","affiliation":[{"name":"Xifeng County People\u2019s Hospital of Guiyang City","place":["Guiyang, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hu","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Army Medical University (Southwest Hospital)","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e250424","DOI":"10.1136\/bcr-2022-250424","article-title":"Relapse of idiopathic acute fibrinous and organising pneumonia 12 years after successful treatment with corticosteroids","volume":"15","author":"Mcnally","year":"2022","journal-title":"BMJ Case Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"101641","DOI":"10.1016\/j.rmcr.2022.101641","article-title":"Aspergillus niger acute respiratory failure due to infection with acute fibrinous and organazing pneumonia: a case report","volume":"37","author":"Okamura","year":"2022","journal-title":"Respir Med Case Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12890-020-1145-7","article-title":"A case report of fungal infection associated acute fibrinous and organizing pneumonitis","volume":"20","author":"Zhao","year":"2020","journal-title":"BMC Pulm Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1186\/s12879-021-06868-0","article-title":"Acute fibrinous and organizing pneumonia complicated with hemophagocytic lymphohistiocytosis caused by chronic active Epstein-Barr virus infection: a case report","volume":"21","author":"Wu","year":"2021","journal-title":"BMC Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"11","DOI":"10.5339\/qmj.2024.qitc.11","article-title":"Acute fibrinous and organizing pneumonia (AFOP): a case series","volume":"2024","author":"Ahmed","year":"2024","journal-title":"Qatar Med J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1111\/crj.13626","article-title":"Pulmonary tuberculosis associated acute fibrinous and organizing pneumonia: a case report and literature review","volume":"17","author":"Zhao","year":"2023","journal-title":"Clin Respir J"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1186\/s12890-022-01997-x","article-title":"Acute fibrinous and organizing pneumonia in a patient with Sj\u00f6gren's syndrome and Legionella pneumonia: a case report and literature review","volume":"22","author":"Lu","year":"2022","journal-title":"BMC Pulm Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e1313","DOI":"10.1002\/rcr2.1313","article-title":"An autopsy case of acute fibrinous and organizing pneumonia with periorbital MRSA cellulitis and rheumatoid arthritis","volume":"12","author":"Hara","year":"2024","journal-title":"Respirol Case Rep"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3960\/jslrt.20042","article-title":"Acute fibrinous and organizing pneumonia following hemophagocytic syndrome in two adult patients with hematological malignancies","volume":"61","author":"Nanno","year":"2021","journal-title":"J Clin Exp Hematop"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1047783","DOI":"10.3389\/fmed.2022.1047783","article-title":"Case report: corticosteroid-resistant acute fibrinous and organizing pneumonia with myelodysplastic syndrome","volume":"9","author":"Jiang","year":"2022","journal-title":"Front Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"673573","DOI":"10.3389\/fmed.2021.673573","article-title":"Case report: diagnosis of myelodysplastic syndrome in a 72-year-old female with interstitial lung disease","volume":"8","author":"Bizymi","year":"2021","journal-title":"Front Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"8396","DOI":"10.21037\/apm-20-2344","article-title":"Acute fibrinous and organizing pneumonia with myelodysplastic syndrome and pneumocystis jiroveci pneumonia: a case report","volume":"10","author":"Lin","year":"2021","journal-title":"Ann Palliat Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e00681","DOI":"10.1002\/rcr2.681","article-title":"Paraneoplastic acute fibrinous and organizing pneumonia from lymphoma completely responding to bendamustine-rituximab","volume":"8","author":"Crowhurst","year":"2020","journal-title":"Respirol Case Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"559","DOI":"10.2169\/internalmedicine.7184-21","article-title":"A rare case of acute fibrinous and organizing pneumonia associated with systemic lupus erythematosus and autoimmune-associated Hemophagocytic syndrome: the involvement of CD163-positive macrophages","volume":"61","author":"Taira","year":"2022","journal-title":"Int Med (Tokyo, Japan)"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s13000-021-01155-7","article-title":"Acute fibrinous and organizing pfneumonia: two case reports and literature review","volume":"16","author":"Chen","year":"2021","journal-title":"Diagn Pathol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e92","DOI":"10.1164\/rccm.202101-0020IM","article-title":"Epirubicin and cyclophosphamide-induced acute fibrinous and organizing pneumonia","volume":"204","author":"Naraoka","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e01357","DOI":"10.1002\/rcr2.1357","article-title":"A challenging case of drug-related acute fibrinous and organizing pneumonia: a rare case report","volume":"12","author":"Guo","year":"2024","journal-title":"Respirol Case Rep"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1186\/s13256-021-02670-3","article-title":"Steroid-refractory dermatologic and pulmonary toxicity in a patient on rituximab treated with pembrolizumab for progressive urothelial carcinoma: a case report","volume":"15","author":"Hines","year":"2021","journal-title":"J Med Case Rep"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"101993","DOI":"10.1016\/j.rmcr.2024.101993","article-title":"A rare pulmonary manifestation of Crohn's disease: acute fibrinous and organizing pneumonia presenting as multifocal nodules","volume":"48","author":"Mistry","year":"2024","journal-title":"Respir Med Case Rep"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1016\/j.resinv.2024.01.014","article-title":"Spontaneous regression of acute fibrinous organizing pneumonia induced by COVID-19 vaccination: a case report","volume":"62","author":"Haga","year":"2024","journal-title":"Respir Investig"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1186\/s13256-022-03619-w","article-title":"Flecainide-induced pneumonitis: a case report","volume":"16","author":"Moureau","year":"2022","journal-title":"J Med Case Rep"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"44","DOI":"10.21037\/acr-22-88","article-title":"Lesson of urgent bilateral lobar lung transplantation for acute fibrinous and organizing pneumonia: a case report","volume":"7","author":"Ye","year":"2023","journal-title":"AME Case Rep"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e230868","DOI":"10.1136\/bcr-2019-230868","article-title":"Acute fibrinous organising pneumonia presenting as a cavitary lung lesion and treatment response to azithromycin","volume":"12","author":"Aslam","year":"2019","journal-title":"BMJ Case Rep"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"13381","DOI":"10.12998\/wjcc.v10.i36.13381","article-title":"Two methods of lung biopsy for histological confirmation of acute fibrinous and organizing pneumonia: a case report","volume":"10","author":"Liu","year":"2022","journal-title":"World J Clin Cases"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e43563","DOI":"10.7759\/cureus.43563","article-title":"Cryptogenic acute fibrinous and organizing pneumonia: a case report","volume":"15","author":"Lim","year":"2023","journal-title":"Cureus"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e36093","DOI":"10.1097\/MD.0000000000036093","article-title":"A case report: acute fibrinous and organizing pneumonia","volume":"102","author":"Liu","year":"2023","journal-title":"Medicine"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s12890-019-0861-3","article-title":"Acute fibrinous and organizing pneumonia: two case reports and literature review","volume":"19","author":"Lu","year":"2019","journal-title":"BMC Pulm Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1901693\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:25:15Z","timestamp":1786944315000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1901693\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":27,"alternative-id":["10.3389\/fmed.2026.1901693"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1901693","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"article-number":"1901693"}}