Bronchiolitis Obliterans Organizing Pneumonia after Radiotherapy: A Case Report of Post-Esophagectomy Diagnosis

Bronchiolitis obliterans organizing pneumonia (BOOP) is a diffuse, infiltrative lung disease. BOOP is mostly idiopathic, and possible causes are pulmonary infections, drugs, collagen vascular disease, thyroiditis, or radiotherapy. Radiation injury to the lung is a common event after radiotherapy. This article presents a case report of BOOP occurrence after minimally invasive esophagectomy that was possibly associated with radiotherapy. The patient, a 66-year-old woman, was diagnosed with middle third esophageal squamous cell carcinoma. The patient received neoadjuvant chemoradiotherapy. Nine months after neoadjuvant therapy, the patient underwent a minimally invasive thoraco-laparoscopic esophagectomy. During the post-operative (PO) period, the patient complained of dyspnea and presented hypoxemic findings in arterial gasometry. We made the diagnosis of BOOP by a lung biopsy using right thoracotomy and histopathological findings. Based on this diagnosis, we initiated the administration of methylprednisolone. The patient showed clinical improvement after the initiation of corticotherapy. This is the first case of BOOP diagnosed during the early post-operative period of an esophagectomy. This case report serves to increase the awareness of interstitial lung disease in the differential diagnosis of patients presenting with lung infiltrates after radiotherapy. Thus, patients who do not have quick resolution of infiltrates should receive additional investigation.