Chronic Interstitial Pulmonary Fibrosis Research Articles

Systematic literature review investigating whether methotrexate causes chronic pulmonary fibrosis.

Methotrexate is a treatment widely used in many medical conditions. It is highly effective especially in conditions such as rheumatoid arthritis (RA) and psoriasis. Methotrexate is associated with a potentially fatal acute methotrexate pneumonitis. In regards to chronic lung complications, three case reports with a total of four patients have suggested a link between methotrexate and chronic lung fibrosis.1–3 Subsequent longitudinal studies have refuted this claim.4,5 The aim in this study is to undertake a systematic literature review to evaluate the published evidence on whether methotrexate causes chronic interstitial pulmonary fibrosis in humans. …

Systematic literature review investigating whether methotrexate causes chronic pulmonary fibrosis

Methotrexate is a treatment widely used in many medical conditions. It is highly effective especially in conditions such as rheumatoid arthritis (RA) and psoriasis. Methotrexate is associated with a potentially fatal acute methotrexate pneumonitis. In regards to chronic lung complications, three case reports with a total of four patients have suggested a link between methotrexate and chronic lung fibrosis.1–3 Subsequent longitudinal studies have refuted this claim.4,5 The aim in this study is to undertake a systematic literature review to evaluate the published evidence on whether methotrexate causes chronic interstitial pulmonary fibrosis in humans. …

The successful treatment of a recurrent intracranial, dural-based plasmacytoma with lenalidomide

A 75 year old woman presented in October of 2008 with new onset symptoms of headaches, difficulty with penmanship, forgetfulness and vertigo. Her past medical history includes sarcoidosis and osteoporosis. As a result of the sarcoidosis, she has chronic interstitial pulmonary fibrosis but refused treatment with chronic steroids. The physical exam was unremarkable and her Karnofsky performance status was 80. She was evaluated for vestibular abnormalities and a magnetic resonance imaging (MRI) with and without gadolinium was obtained. This demonstrated an enhancing extra-axial, dural-based mass in the high biparietal region, measuring 3.0 cm 9 6.6 cm in the axial plane and encasing the superior sagittal sinus. This was initially thought to represent a meningioma. She underwent a stereotactic biopsy of the mass. The Haematoxylin & Eosin (HE whereas the majority of cells were positive for EMA, and all were strongly positive for MUM-1 (Fig. 1b–d). IHC stains were strongly positive for kappa light chains and negative for lambda chains demonstrating the clonality of the plasma cells in the specimen (Fig. 1e, f). Both serum and urine immunofixation showed no evidence of a monoclonal protein. Serum free light chain ratio was also normal. The blood counts, serum creatinine and calcium are normal. A bone marrow biopsy revealed no evidence of a plasma cell dyscrasia and a skeletal survey showed no destructive lytic lesions, thus effectively ruling out multiple myeloma. Due to the solitary location of the tumor, she was treated with image-modulated radiation therapy (IMRT) in November of 2008, receiving a total of 4,500 cGy. Following this treatment, her MRI normalized and her symptoms improved including the resolution of her headaches. In August 2009, a repeat MRI revealed a new area of dural thickening in a region that had not previously received radiotherapy. She received a second course of IMRT of 4,500 cGy in 25 fractions in September of 2009. A post-treatment MRI showed another complete response. In June 2010, an MRI revealed a new, third homogeneously enhancing lesion measuring approximately 5.3 cm in cranial-caudal dimension (Fig. 2a). Due to the extent of prior radiation therapy and her advanced age, alternatives to radiotherapy were considered in an attempt to avoid excessive neurotoxicity. Given the dural nature of the lesion, it was thought that systemic therapy could access and treat the lesion. A previously published study evaluated the use of low dose dexamethasone combined with lenalidomide (Revlimid ; Celgene Corp., Summit, NJ) for multiple myeloma, and demonstrated an improved time to progression and overall C. E. Devoe (&) Monter Cancer Center, Hofstra North Shore-LIJ School of Medicine, North Shore-Long Island Jewish Health System, 450 Lakeville Road, Lake Success, NY 11042, USA e-mail: CDevoe@NSHS.edu

Alterations in the Cellular Population of the Alveolar Wall in an Animal Model of Fibrosis: A Morphometric Study

A reproducible animal model of interstitial pulmonary fibrosis is generated in rodents by intratracheal injection of the antineoplastic drug, bleomycin sulfate. Pulmonary lesions resemble closely those observed in human patients with fibrosis. Fibrotic lesions are most pronounced 3–4 weeks after the drug's instillation. 1 Snider GL Hayes JA Korthy AL Chronic interstitial pulmonary fibrosis produced in hamsters by endotracheal bleomycin: pathology and stereology. Am Rev Respir Dis. 1978; 117: 1099-1108 PubMed Google Scholar Histologically, increased interstitial connective tissue and hypercellularity are observed. 1 Snider GL Hayes JA Korthy AL Chronic interstitial pulmonary fibrosis produced in hamsters by endotracheal bleomycin: pathology and stereology. Am Rev Respir Dis. 1978; 117: 1099-1108 PubMed Google Scholar Biochemical assays reveal increased lung collagen and elastin, 2 Starcher BC Kuhn C Overton JE Increased elastin and collagen content in the lungs of hamsters receiving an intratracheal injection of bleomycin. Am Rev Respir Dis. 1978; 117: 299-305 PubMed Google Scholar and physiologic measurements show reduced compliance and decreased lung volumes, as those observed in humans with the disease. 3 Snider GL Celli BR Goldstein RH O'Brien JJ Lucey EC Chronic interstitial pulmonary fibrosis produced in hamsters by endotracheal bleomycin: lung volumes, volume-pressure relations, carbon monoxide uptake, and arterial blood gas studies. Am Rev Respir Dis. 1978; 117: 289-297 PubMed Google Scholar , 4 Kelley J Newman R Evans JN Bleomycin-induced pulmonary fibrosis in the rat: prevention with an inhibitor of collagen synthesis. J Lab Clin Med. 1980; 96: 954-964 PubMed Google Scholar

Chronic interstitial pulmonary fibrosis following mycoplasma pneumoniae pneumonia

An unusual case of chronic interstitial fibrosis that developed as a sequela of Mycoplasma pneumoniae pneumonia is described. Predominant manifestations included progressive exertional dyspnea, shortness of breath, persisting lung infiltrates, low lung volumes, and low pulmonary diffusing capacity. Open lung biopsy one year after the acute stage of mycoplasma pneumonia revealed focal interstitial fibrosis with early pleural thickening, hypertrophic alveolar lining cells, and peribronchiolar lymphoid cell infiltrates. Improvement in clinical manifestations, radiologic findings, and pulmonary function results occurred with steroid therapy.

Chronic interstitial pulmonary fibrosis produced in hamsters by endotracheal bleomycin: pathology and stereology.

An animal model of chronic interstitial pulmonary fibrosis was produced in male golden hamsters by a single endotracheal instillation of 0.5 unit of bleomycin per 100 g of body weight. Interstitial edema and polymorphonuclear cell infiltration during the early days were followed by marked al­ veolar and bronchiolar epithelial cell proliferation, interstitial pulmonary fibrosis, and predomi­ nance of round cell response, which reached a peak at approximately 30 days. The process then waned slowly, attaining stability at 90 days; foci of chronic interstitial fibrosis with round cell in­ filtration were still found in all animals at 180 days. The mortality rate was 17 per cent, with deaths occurring up to day 41; most animals died in the early stages. A lung disease index was measured stereologically by scanning 3 lung sections from each animal with a grid and determining the percentage of lung that was diseased, irrespective of the nature of the disease process. Mean values of the index at 8, 30, 60, 90, and 180 days after bleomycin were: 21.7, 40.3, 28.2,12.1, and 13.0 per cent, respectively; all of these values were significantly different from the control value of 1.1 per cent (P < 0.001). In 25 animals treated with bleomycin, the coefficients of correlation between the disease index and lung compliance, vital capacity, inspiratory capacity, and total lung capacity determined physiologically, were -0.63, -0.68, and -0.43, respectively. We conclude that this ani­ mal model of interstitial pulmonary fibrosis should be of value in studying cellular and biochemi­ cal events in the lung and in exploring various therapeutic strategies.

Chronic interstitial pulmonary fibrosis produced in hamsters by endotracheal bleomycin. Lung volumes, volume-pressure relations, carbon monoxide uptake, and arterial blood gas studied.

Chronic interstitial pulmonary fibrosis produced in hamsters by endotracheal bleomycin. Lung volumes, volume-pressure relations, carbon monoxide uptake, and arterial blood gas studied.

Eosinophilic gastroenteritis with malabsorption, extensive villous atrophy, recurrent hemorrhage and chronic pulmonary fibrosis.

A patient with diffuse eosinophilic gastroenteritis, associated with progressive chronic interstitial pulmonary fibrosis, was followed for 29 years. His major symptoms were recurrent gastrointestinal bleeding, anemia, diarrhea, malabsorption, and increasing respiratory insufficiency. Multiple jejunal biopsies revealed eosinophilic infiltration and extensive villous atrophy. Results of a lung biopsy and pulmonary function tests were consistent with chronic interstitial pulmonary fibrosis. His gastrointestinal symptoms responded to steroid therapy, but he died of progressive respiratory insufficiency. At autopsy, villous atrophy was noted to extend throughout the whole extent of the small intestine in association with multiple "pseudopolypoidal" inflammatory lesions.