Acute fibrinous and organizing pneumonia (AFOP)is a relatively rare diffuse pulmonary substantial disease.This article reported one patient with AFOP confirmed by pathological examination.The female patient,aged 56 years,presented with fever,cough and gradually worsening dyspnea.Chest CT scan revealed multiple patchy and nodular shadows,accompanied by a slight quantity of pleural effusion.She was initially diagnosed with community acquired pneumonia.After anti-bacterial therapy,the symptom of dyspnea was deteriorated.Repeated chest CT showed an increasing quantity of patchy and nodular masses in bilateral lung.Bronchoscopy revealed no signs of tracheal stenosis or airway obstruction by sputum.Computed tomo-graphy-guided percutaneous lung biopsy revealed that lymph cell infiltrate was distributed in the pulmonary al-veoli and fibrin-like red staining and organizing tissue in the alveoli.No signs of neutrophilic or eosinophilic in-filtration were noted.These symptoms were consistent with those of AFOP.Following glucocorticoid therapy, clinical and imaging symptoms were rapidly alleviated.The diagnosis and treatment of this case hinted that it is likely to misdiagnose AFOP with pneumonia due to non-specific clinical manifestations.Anti-infection therapy yielded no effect upon AFOP.AFOP patients presented with specific pathological characteristics and had high response to glucocorticoid therapy.%急性纤维素性机化性肺炎（AFOP）是一种较少见的肺部弥漫性实质性疾病。该文报道了1例经病理证实的 AFOP 患者。患者为女性，56岁，临床表现为发热、咳嗽伴有呼吸困难逐渐加重，胸部 CT 示双肺多发团片状影和结节影，伴少量胸腔积液。初步诊断为社区获得性肺炎，经验性抗菌药物治疗无效后，呼吸困难加重，胸部 CT 显示双肺团片状影和结节影增多。气管镜检查未见气管管腔狭窄及痰液阻塞。CT 引导下经皮肺穿刺活组织病理检查结果示，肺泡内见散在淋巴细胞浸润，肺泡腔内见纤维素样红染物质伴机化，未见中性粒细胞和嗜酸粒细胞浸润，病变符合 AFOP。经肾上腺皮质激素（激素）治疗后症状很快缓解，胸部影像学改变明显好转。该例诊治过程提示，AFOP 临床特征缺乏特异性，临床上易被误诊为肺炎，抗感染治疗无效。AFOP 具有独特的病理表现，对激素有良好的治疗反应。
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