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Age and Ageing 2008; 37: 235–235 The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society.
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Clinical Reminders
A case of bronchiolitis obliterans organising
pneumoniae (BOOP) after nine months
post-operative irradiation for breast cancer
A 71-year-old woman was referred to our unit with
fever (38.5
◦
C). During the preceding 3 weeks she reported
sweats and non-productive cough despite previous antibiotic
therapy. In May 2005 she had undergone a quadrantectomy
and sentinel-node biopsy at our hospital for right upper-
outer quadrant breast cancer. She received radiation
therapy through conventional tangential-field irradiation
using photons from August to September 2005.
Chest X-ray showed a right-sided pulmonary area of
consolidation. CT scan demonstrated dense pneumonic
infiltrate with bronchograms in the right mid-lobe. A
second CT scan (21 days after the first) (see Figure 1a
in the supplementary data on the journal’s website
http://www.ageing.oxfordjournals.org) showed patchy con-
solidation in the right mid-lobe and the appearance of
bilateral nodules (diameter 1–2 cm) at the posterior segment
of the right upper lobe. The patient underwent lung biopsies
via bronchoscopy at the mid- and upper right lobes from
the radiographically abnormal area. Histology confirmed the
diagnosis of bronchiolitis obliterans organising pneumoniae
(BOOP).
After oral prednisone there was a dramatic resolution
of respiratory symptoms within 1 week, and a CT
scan (see Figure 1b in the supplementary data on the
journal’s website http://www.ageing.oxfordjournals.org)
3 weeks after initiating steroid therapy, showed resolution of
the right area of consolidation.
This case implies that BOOP should always be kept in
mind when treating patients who present these types of
symptoms following irradiation of the breast [1–3].
Conflicts of interest
None
LUISA BISSOLI,VINCENZO DI FRANCESCO,FILIPPO VALBUSA,
A
LESSANDRA ZIVELONGHI,FRANCESCO FANTIN
∗
,MAURO ZAMBONI
Division of Geriatric Medicine, University of Verona, Ospedale
Maggiore, P.le Stefani 1, 37126 Verona, Italy
Tel: (+39)-45-8 122 537; Fax: (+39)-45-8 122 043
Email: francescofantin@hotmail.com
∗
To whom correspondence should be addressed
Supplementary data
Supplementary data for this article are available online at
http://ageing.oxfordjournals.org.
1. Davis SD, Yankelevitz DH, Henschke CI. Radiation effects of
the lung: clinical features, pathology and imaging findings. Am
J Roentgenol 1992; 159: 1157–64.
2. Miwa S, Morita S, Suda T, et al. The incidence and clinical
characteristics of bronchiolitis obliterans organizing pneumonia
syndrome after radiation therapy for breast cancer. Sarcoidosis
Vasc Diffuse Lung Dis 2004; 21: 212–8.
3. Crestani B, Kambouchner M, Soler P, et al. Migratory bronchio-
litis obliterans organizing pneumonia after unilateral radiation
therapy for breast carcinoma. Eur Respir J 1995; 8: 318–21.
doi:10.1093/ageing/afn010
Re-infection with primary varicella zoster
in older people
Primary chickenpox is rare in older people as there is almost
universal seroconversion by early adulthood. Re-infection
with chickenpox in the absence of immunosuppression and
presence of specific antibodies is even rarer but has been
reported [1].
An 82-year-old previously healthy man developed a gener-
alised blistering rash (see Figure 1 in the supplementary data
on the journal’s website http://www.ageing.oxfordjournals.
org) diagnosed by his GP as pemphigus and treated with
prednisolone 60 mg daily. He deteriorated and developed
pneumonitis and respiratory failure needing high depen-
dency care. Diagnosis of chickenpox was confirmed by
positive varicella zoster PCR. His serology showed positive
varicella zoster IgG antibodies with a delayed rise in titres by
day 29. He responded well to treatment with aciclovir.
Chickenpox should still be considered in the elderly as
misdiagnosis and inappropriate treatment delays diagnosis
and increases the risk of complications.
Conflicts of interest
None
INDUNIL GUNAWARDENA
1∗
,THURUL ATTYGALLE
2
1
Department of Medicine for Elderly People, Queen
Alexandra Hospital, Portsmouth, UK
E-mail:indunil.gunawardena@nhs.net
2
Medicine for the Elderly, Colchester General Hospital, UK
∗
To whom correspondence should be addressed
Supplementary data
Supplementary data for this article are available online at
http://ageing.oxfordjournals.org.
1. Gershon AA, Steinberg SP, Gelb L. Clinical reinfection with
varicella-zoster virus. J Infect Dis 1984; 149: 137–42.
doi:10.1093/ageing/afn005
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