Reticular Shadows Research Articles

Hermansky-Pudlak syndrome-associated pneumothorax with rapid progression of respiratory failure: a case report

BackgroundHermansky-Pudlak syndrome (HPS) is an extremely rare disease with pulmonary fibrosis (PF), oculocutaneous albinism, induced platelet dysfunction, and granulomatous colitis. Although patients with HPS-associated PF (HPS-PF) often receive treatment with anti-fibrotic agents, including pirfenidone, many HPS-PF cases are progressive. The development of pneumothorax is known to be rare in HPS-PF. Pneumothorax development is generally important for prognosis in patients with interstitial pneumonia. However, there are few reports regarding the development of pneumothorax in patients with HPS-PF.Case presentationA 50-year-old Japanese man with chestnut hair, white skin, and light brown squint eyes visited our hospital for interstitial pneumonia examination. Chest high-resolution computed tomography (HRCT) demonstrated diffuse bilateral reticular opacities along the bronchovascular bundles and traction bronchiectasis predominantly in the upper lung fields. He was definitively diagnosed with HPS because genetic analysis showed that he had a homozygous mutation, c.398 + 5G > A, in the HPS-1 gene. After diagnosis with HPS-PF, he initiated home oxygen therapy due to gradually progressive hypoxemia.Three months after the HPS-PF diagnosis, the patient suddenly developed severe chest pain and dyspnea and was admitted to our hospital on emergency. He was diagnosed with pneumothorax by chest radiological findings. He immediately received chest drainage; however, his pneumothorax did not improve. Therefore, he underwent video-assisted surgery by thoracic surgeons. The leak point was not detected, but multiple bullae were found, mainly in the upper lung lobes. Thus, the surgeons did not perform bullectomy and only covered the apical areas. Fifteen days after the surgery, the patient developed high fever and dyspnea with a new diffuse reticular shadow found through HRCT. We first initiated the patient on broad-spectrum antibiotics; however, the symptoms and radiological findings worsened. Therefore, we started treatment with pirfenidone for inhibition of PF progression. The patient re-developed pneumothorax with severe respiratory failure. Although he re-underwent chest drainage, he died of progressive respiratory failure.ConclusionsWe herein report the case of a rare HPS patient who developed pneumothorax with progressive PF. Pneumothorax may cause rapid progressive respiratory failure and may be associated with PF progression in HPS-PF.

Assessment of Lung Function using Spirometry and Radiological findings in Post Tuberculosis Cases


 
 
 Objective: To assess the prevalence of abnormal radiological changes and their impact on lung function in post tuberculosis cases. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in medical Outpatient Department (OPD) of CMH, Quetta from 30th Nov 2018 to 30th May 2019. Materials and Methods: A total of sixty treated cases of pulmonary tuberculosis, presenting in medical OPD of CMH Quetta for regular follow-up, were included in the study. The subjects were recruited by non-probability consecutive sampling technique according to predefined inclusion criteria. Demographic data including age, gender, post treatment duration, clinical features and history of asthma, atopy, rhinitis, biomass exposure, coalmine exposure, animal and pet exposure was collected. Their lung function was assessed using spirometry and radiological changes were assessed by either chest X-ray or high resolution CT chest. Results: Among the 60 patients, mean age was 36.32 + 9.95 years. The majority (70%) of subjects were males (n=42).The mean duration post treatment was 4.79 + 4.25 years. Among the study population 51.7% (n=31) were symptomatic, 73.3% (n=44) had abnormal lung function tests. With those having abnormal lung functions tests, 23.3% (n=14) had obstructive, 43.3% (n=26) had restrictive and 6.7% (n=4) had mixed airway disease. The radiological investigations were abnormal in 80% (n=48) of the patients showing various radiological changes such as reticular shadows, nodules, pleural thickening, collapse, fibrotic bands, hilar calcifications, lung volume reduction and traction bronchiectasis. Conclusion: Our study showed that the restrictive pattern was most common finding on spirometry while, fibrotic bands were the most common radiological findings in post tuberculosis cases in our population.
 
 

Postoperative acute exacerbation of interstitial lung disease after pneumonectomy: clinical analysis of four cases

Objective To summarize the clinical features, diagnosis and treatment of postoperative acute exacerbation of interstitial lung disease (ILD) after pneumonectomy. Methods The clinical data of 4 patients with postoperative acute exacerbation of ILD after pneumonectomy admitted in Beijing Hospital from October 2014 to November 2015 were retrospectively analyzed and related literatures were reviewed. Results Four patients were aged 60 to 74 years, including 3 males and 1 female, 2 of whom were idiopathic pulmonary fibrosis and 2 were connective tissue diseases related ILD. Chest high resolution computed tomography (HRCT) showed multiple lobular septal thickening, ground glass opacities, reticular shadow and strip shadow in both lungs. The patients developed acute dyspnea 2 to 3 days after pneumonectomy. In 2 cases, HRCT showed new patchy ground-glass opacities, reticular shadow and strip shadow in both lungs on the basis of preoperative pulmonary fibrosis. The sputum smear and culture showed no pulmonary infection in all 4 cases. Three patients were treated with glucocorticoids and 3 received mechanical ventilation with endotracheal intubation. One patient was successfully treated by early using adequate glucocorticoids, one patient improved after treatment but died after re-exacerbation, and the other two patients died after treatment failed. Conclusions Acute exacerbation of ILD after pneumonectomy often occurs in early postoperative period and it is characterized by progressive dyspnea. Chest CT and respiratory pathogen examination are helpful for early diagnosis. Postoperative acute exacerbation of ILD often lacks effective treatment, requires mechanical ventilation, and the prognosis is poor. Although glucocorticoids may be effective, re-exacerbation should be alert during treatment. Key words: Lung diseases, interstitial; Idiopathic pulmonary fibrosis; Pneumonectomy; Acute exacerbation

Eosinophilic Pneumonia Putatively Induced by Vancomycin: A Case Report

Patient: Male, 65Final Diagnosis: Eosinophilic Pneumonia putatively induced by vancomycinSymptoms: Dyspnea • fatigue • fever • hypoxiaMedication: VancomycinClinical Procedure: Discontinuation of vancomycin and administration of prednisoloneSpecialty: General and Internal MedicineObjective:Adverse events of drug therapyBackground:Herein, we describe a case of eosinophilic pneumonia that was likely to have been induced by vancomycin.Case Report:A 65-year-old man on maintenance hemodialysis presented with chest pain and dyspnea. He subsequently developed methicillin-resistant Staphylococcus aureus-positive acute pleural empyema in an evacuated right-sided pneumothorax. Surgical thoracoscopic curettage was ultimately performed, but dyspnea recurred postoperatively. Computed tomography depicted widespread reticular shadowing of the left lung, and peripheral eosinophilia was detected. The proportion of eosinophils found in bronchoalveolar lavage fluid was also remarkable (43%). All symptoms and the results of laboratory tests immediately improved after the discontinuation of vancomycin and initiation of prednisolone therapy.Conclusions:We attribute this case of eosinophilic pneumonia to vancomycin, because all other candidate causes were ruled out, and only vancomycin fulfilled the criteria of both drug-induced eosinophilic pneumonia and drug-induced lung injury. If confirmed, this constitutes the first reported case of vancomycin-induced eosinophilic pneumonia.

Interference research of umbilical cord mesenchymal stem cells on the pulmonary fibrosis in silicosis rats

Objective: To explore the effect of the umbilical cord mesenchymal stem cells(UC-MSCs) on the pulmonary fibrosis in silicosis rats. Methods: SPF male Sprague Dawley rats were randomly divided into control group, silica model group and UC-MSCs treatment group with 12 rats each group. SiO(2) intra-tracheal injection(0.5 ml of 50 mg/ml/rat) were applied to silica model group and UC-MSCs treatment groups. After that UC-MSCs treatment group received 1 ml UC-MSCs suspension (3×10(6) cells/ml) by tail vein injection on the 29th, 36th, 43th and 50th day after exposure to the first silica suspension. On the 60th and 75th day after exposure to silica suspension, all animals were examed for pulmonary CT. Then the rats were euthanized on 75th day after the first exposure to silica.Lung's histopathological examination of the rats from all the groups were carried out. The content of hydroxyproline in lungs, TGF-β1 and IL-6 in serum were examined. Results: The lung's histopathological examination showed no obvious inflammatory cell and no fibrosis in the lung tissue of the control group, there were a lot of inflammatory cell aggregation and collagen fiber deposition in silica model group, while in the UC-MSCs intervention group and treatment group, there were less inflammatory cells and collagen fiber. The rats from silica model groups had higher HYP, TGF-β1 and IL-6 than the rats from UC-MSCs treatment group and control group. Lung fields of rats in the control group were clear and no obvious high-density shadow. Different-sized granular high-density shadows or reticular fibrous shadows were found diffusely distributed in the lungs of the rats in silica model group. Lung field of rats in UC-MSCs intervention group and treatment group were less high density shadows, and more clear. Conclusion: UC-MSCs can alleviate the pulmonary fibrosis in silica model rats through regulating the secretion of some fibrosis related cytokines.

Interstitial pneumonia suspected during regorafenib administration and exacerbated by subsequent therapy with lenvatinib for unresectable hepatocellular carcinoma

Recently, three tyrosine kinase inhibitors (TKIs) have become available for treatment of unresectable hepatocellular carcinoma (HCC). We herein report a case of a 59-year-old man with interstitial pneumonia that was suspected during regorafenib administration and was exacerbated by subsequent lenvatinib treatment for advanced HCC. After sorafenib was discontinued due to progressive HCC, regorafenib treatment was started. Progressive HCC was again noted and reticular shadows were suspected in both lower lung fields at 2months after starting regorafenib administration. Subsequent treatment with lenvatinib obtained a partial response for HCC, but the reticular shadows became marked and dyspnea on effort emerged, followed by hypoxemia and an increased Krebs von den Lungen-6 (KL-6) value. Because we suspected acute interstitial pneumonia, due to these TKIs, intravenous pulse steroid therapy was started immediately after discontinuing lenvatinib. Within 1 week after starting steroid therapy, the patient's respiratory condition and hypoxemia gradually began improving. No previous case of pulmonary interstitial changes that appeared in association with regorafenib administration for HCC and that were exacerbated by subsequent treatment with lenvatinib has been reported. This case emphasizes that it is necessary to observe the patient's respiratory condition and to perform imaging examinations to monitor for adverse events during TKI treatment.

Clinical characteristics of connective tissue disease-related interstitial lung disease: an analysis of 186 cases

Objective To analyze the clinical characteristics of connective tissue disease related interstitial lung disease (CTD-ILD). Methods The demographic data, clinical manifestations, blood gas analysis, lung function, chest high resolution CT (HRCT), histopathology of 186 patients with CTD-ILD admitted in Jinhua Central Hospital from January 2013 to December 2017 were retrospectively analyzed. Results In 186 patients with CTD-ILD,70 were males and 116 were females, with a mean age of 56.22±12.27. Among them, 61 cases were polymyositis/dermatomyositis (DM/PM)-ILD, 44 cases were rheumatoid arthritis (RA)-ILD, 26 cases were interstitial pneumonia with autoimmune features (IPAF), 16 cases were systemic sclerosis (SSc)-ILD, 14 cases were Sjogren syndrome (SS)-ILD, 11 cases were overlap syndrome (OS)-ILD, 7 cases were systemic lupus erythematosus (SLE)-ILD, 5 cases were undifferentiated connective tissue disease (UCTD)-ILD, and 2 cases were mixed connective tissue disease (MCTD)-ILD. The incidence of respiratory symptoms was higher than that of systemic symptoms, and the incidence of systemic symptoms was higher than that of skin symptoms. Cough was the most common symptom of respiratory system, and arthralgia was the most common symptom of systemic symptoms, accounting for 54.9% (101/186) and 48.9% (91/186) respectively. Blood gas analysis showed that hypoxemia accounted for 56.5% (83/147) and type Ⅰ respiratory failure accounted for 26.5% (39/147) . The proportion of restrictive ventilation dysfunction in pulmonary function tests was 70.9% (105/148) and the diffuse dysfunction was 81.1% (120/148) . The manifestations on HRCT were reticular linear shadow (44.1%), ground-glass opacity (54.3%), consolidation (23.1%), nodules shadow (20.9%) and cystic low density shadow (9.1%) . The histopathological diagnosis mainly was non-specific interstitial pneumonia (NSIP, 43.0%) and usual interstitial pneumonia (UIP,40.0%). Conclusion The arterial blood gas analysis, lung function and chest HRCT screening, and lung histopathological examination are important for early identification and diagnosis of CTD-ILD. Key words: Connective tissue diseases; Lung diseases, interstitial; Blood gas analysis

Correlation between disease activity and serum ferritin in clinically amyopathic dermatomyositis with rapidly-progressive interstitial lung disease: a case report

BackgroundClinically amyopathic dermatomyositis with anti-Melanoma Differentiation-Associated gene 5 (MDA5) antibody often presents with severe interstitial lung disease. Although serum ferritin level is known to reflect interstitial lung disease activity, there are few case reports describing this association.Case presentationA 58-year-old man was referred to our outpatient clinic with a 3-week history of cough and respiratory distress. He had erythema over the V area of the neck and a Gottron’s sign. Chest computed tomography revealed diffuse ground-glass opacities and reticular shadows in both lungs. Test for anti-MDA5 antibody was positive. After admission, he received triple combination therapy (methylprednisolone pulse therapy, tacrolimus, and cyclophosphamide). However, his respiratory condition worsened as the serum ferritin level increased. Despite no apparent deterioration on chest radiography, he ultimately died due to respiratory failure.ConclusionsIn this case, triple combination therapy was not effective for the patient’s respiratory condition. The serum ferritin level was correlated with disease activity and was more useful than chest radiography for monitoring clinical status.

Clinical characteristics of dermatomyosits/polymyositis associated interstitial lung disease according to the autoantibody.

Dermatomyositis (DM) and polymyositis (PM) often have association with interstitial lung disease (ILD) which have disease specific autoantibody. We reviewed medical records of DM/PM associated ILD from January 2000 to December 2017 according to the autoantibody. We identified 52 patients, of whom 30 were antibody negative, 18 had anti aminoacyl-tRNA synthetases (ARS) antibodies and 4 had anti melanoma differentiation-associated gene (MDA)-5 antibody. In high resolution computed tomography (HRCT) of the chest, area of ground glass opacity (GGO), consolidation, and lung tip consolidation were more extensive in anti MDA-5 antibody positive patients (p=0.051, p=0.026, and p=0.027, respectively). Among laboratory findings, GOT had strong correlations with CPK (r=0.889, p < 0.001), and LDH (r=0.910, p < 0.001). Among roentgenographic findings, there were moderate correlations between GGO and consolidation (r=0.668, p < 0.001), and between reticular shadow and traction bronchiectasis (p=0.633, p < 0.001). ILD patients with anti MDA-5 antibodies had decreased survival (1.00 vs 84.3, 22.9 months, p < 0.001). ILD patients with anti ARS antibody had intense inflammation, but reversible fibrosis and good prognosis. On the other hand, anti MDA-5 antibody positive ILD patients had shorter survival. Extent of parenchymal shadow and serum GOT were useful indicator of disease activity of PM/DM associated ILD patients in our cohort. J. Med. Invest. 65:251-257, August, 2018.

Clinical characterization of 52 patients with immunoglobulin G4-related disease in a single tertiary center in Japan: Special reference to lung disease in thoracic high-resolution computed tomography.

Immunoglobulin G4-related disease (IgG4-RD) is a rare multi-organ disorder. Physicians rarely encounter patients with IgG4-RD and its range of symptoms. To elucidate the clinical characterization of IgG4-RD, along with the clinical significance of lung involvement, we retrospectively reviewed the medical records of patients who satisfied the comprehensive diagnostic criteria for IgG4-RD. We identified 52 patients with IgG4-RD. Of these, 32 patients underwent tissue biopsies, resulting in categorization as definite (n=23) or possible (n=9) IgG4-RD cases. Among the 23 definite IgG4-RD cases, those with positive lung involvement (n=8) had significantly higher values of serum LDH (median 220 IU/L, interquartile range (IQR) 175-378 vs. median 184, IQR 136-249, p=0.039), IgG (median 2769mg/dL, IQR 2028-7807 vs. median 2048, IQR 1168-4376, p=0.009), and soluble interleukin-2 receptors (median 1620 U/mL, IQR 871-2250 vs. median 733, IQR 271-1600, p=0.003) than those with negative lung involvement (n=15). Similarly, a significant number of patients with positive lung involvement were positive for rheumatoid factor (71.4% vs. 23.1%, p=0.041) or hypocomplementemia (50% vs. 0%, p=0.036). Sixteen patients also showed lung involvement (definite n=8, possible n=8); thoracic computed tomography (CT) of these patients revealed mediastinal lymphadenopathies (n=14, 87.5%), ground glass opacity (n=11, 68.8%), consolidation (n=8, 50%), thickening of the bronchovascular bundles (n=7, 43.8%), small nodules (n=5, 31.3%), bronchiectasis (n=4, 25%), and reticular shadows (n=4, 25%), and pulmonary function tests, using a standard technique involving a single breath, revealed decreased diffusion capacity for carbon monoxide. IgG4-RD is associated with diverse thoracic CT findings and a decreased diffusion capacity, and careful multidisciplinary assessment is needed to enable differentiation of IgG4-RD from lymphoproliferative disorders.

PUB014 Nivolumab- Induced Acute Lung Injury in Non-Small Cell Lung Cancer Patients

Nivolumab (Nivo) is a promising and hopeful drug for patients with advanced lung cancer. It is one of immune checkpoint inhibitors targeting programmed cell death protein and brings about the beneficial effect for melanoma, non-small cell lung cancer and renal cell cancer. Over the next few years it is clear that immune checkpoint inhibitor therapy will play an important role in cancer therapy. In this report, we present three patterns of nivo-induced acute lung injury that have experienced in our institute. Three patterns of lung injury are as follows. Firstly, a 65-year-old male with squamous cell cancer after surgery who was administered with nivo in two weeks prior to the short breath and dyspnea. The laboratory findings showed high level of KL-6 (777 U/ml) and surfactant protein-D(1271ng/ml). On chest CT ground glass and reticular shadow were observed in the left lower lobe of the lung. Three times of pulse steroid therapy was carried out at early stage however, the patient was dead on 4 weeks after treatment of nivo. Pathological examination in the damaged lung showed the nonspecific interstitial pneumonia. Secondarly, a 69-year-old female with adenocarcinoma after surgery who was administered with nivo in two days prior to massive hemoptysis and severe respiratory dysfunction prssented. On chest CT, some massive shadows induced by acute alveolar hemorrhage at left lower lobe of lung occurred and the patient resulted in the severe respiratory failure and was dead on the same day. Lastly, A 61-year-old male with squamous cell cancer after surgery who was administered with nivo in a week without any subjective symptoms presented. On chest CT, ground glass shadow at right upper lobe of lung. The Infiltrating shadow along the bronchiovascular bundle was also observed. The pulse steroid therapy was carried out and resulted in the rapid improvement of interstitial change and inflammatory changes in the serum within a week. We have recently experienced three patterns of nivolumab-induced lung injury. As frequent use of nivo will be expected, we have to elucidate a detailed mechanism of lung injury related to this therapy as soon as possible.

Interstitial pneumonia in a patient treated with TAS-102 for metastatic colorectal cancer: a case report

BackgroundTAS-102, a new treatment option for patients with metastatic colorectal cancer that is refractory or intolerant to standard therapies, has been improving survival with acceptable tolerability and adverse events. Adverse hematological events associated with TAS-102 treatment were extensively profiled in the RECOURSE trial, but pulmonary toxicities associated with TAS-102 therapy are distinctly uncommon. In a recent early post-marketing phase vigilance on TAS-102 in Japan, seven cases of pulmonary disease were reported, but patient follow-up in this study was incomplete. Here, we present the first case of interstitial lung disease occurring in association with TAS-102 treatment.Case presentationA 57-year-old Japanese man who had previously received two standard treatments was admitted in 2014, at which time we administered TAS-102 (110 mg/day) as a third-line chemotherapy. He was safely treated with TAS-102 for the first planned cycle; however, approximately 4 days after receiving the second cycle of TAS-102, he complained of high fever and subsequent dyspnea with severe hypoxemia and went to the emergency room. A chest X-ray revealed diffuse coarse reticular shadows with ground-glass opacity on both lungs. Furthermore, a chest computed tomography scan showed thickening of the bronchovascular bundles with extensive ground-glass opacification and pleural effusions in both lung fields.In addition, a peripheral blood lymphocyte stimulation test with TAS-102 showed higher values compared with control samples. Consequently, we suspected drug-induced interstitial pneumonia, and discontinued treatment. Our patient was given an initial administration of high-dose methylprednisolone (1000 mg/day) for 3 days and oxygen. Our patient was discharged with oral prednisolone (20 mg/day) and improved symptomatically and radiologically.ConclusionsThese findings suggest that interstitial pneumonia is a rare complication of TAS-102 chemotherapy, but the possibility of interstitial pneumonia should always be considered when a patient presents with a respiratory disorder while undergoing TAS-102 systemic chemotherapy.Prompt discontinuation of TAS-102 and treatment with high-dosage corticosteroids is needed to avoid exacerbating respiratory symptoms.

AB030. Airway involvement in a patient with ulcerative colitis

Patients with ulcerative colitis can develop pulmonary disease as a result of direct lung involvement due to the disease itself or as a complication of drug treatment. Present history: a 44-year-old man, ex-smoker, presented with gradually deteriorating shortness of breath and cough with purulent expectoration commencing 4 months earlier. Previous history: ulcerative colitis diagnosed 5 months ago under treatment with infliximab and mesalazine (poor compliance). Clinical examination: end inspiratory crackles predominately at lung bases. Absence of clubbing. Diagnostic investigation: (I) chest radiograph: reticular shadows predominately at lung bases; (II) arterial blood gasses (receiving 5 L/min via nasal cannula): pH 7.44, PCO2 36 mmHg, PO2 63 mmHg, HCO3 25 mmol/L; (III) echocardiography: normal; (IV) high resolution lung CT: bronchiectasis and diffuse centrilobular poorly defined nodules with ground glass density; (V) lung function tests: FEV1 2.2 L (60% pred.), FVC 2.6 L (58% pred.), FEV1/FVC 84%, TLC 3.44 L (51% pred.), FRC 2.32 L (69% pred.), DLCO 3.7 mL/min/mmHg (36.1% pred.); (VI) bronchoalveolar lavage: Ly 62%, Neu 3%, Eos 2%, Mφ 30% CD4/CD8 0.38; (VII) thoracoscopic lung biopsy: bronchiectasis, bronchiole smooth muscular hyperplasia and interstitial tissue thickening. Management: the patient was started on prednisolone (0.5 mg/kg of body weight) and within the next 10 days exhibited significant improvement in blood gases values (pH 7.48, pCO2 34, pO2 66 mmHg, HCO3 25 mmol/L. while breathing room air) as well as in his diffusing capacity (DLCO 14.9 mL/min/mmHg). Nevertheless, a 6 minute walking test after 10 days of therapy revealed a significantly reduced walking distance (150 m) with severe desaturation at the end of the test (drop by 7%). Airway involvement is the most common respiratory complication of ulcerative colitis and presents mainly as bronchiectasis (66%) and/or bronchiolitis. Upper airway involvement is less common. Differentiating between respiratory involvement due to ulcerative colitis itself and pulmonary toxicity due to drug treatment is not always straightforward.

Serological Negative Cytomegalovirus Pneumonia Complicated with Bronchiolitis Obliterans Organizing Pneumonia in an Immunocompetent Patient: A Case Report

A 63 year-old man presented with fever, cough, sputum and tachypnea. The latter deteriorated rapidly. A thoracic computed tomography (CT) scan revealed bilateral reticular shadows appearance and quickly spread around two lungs. Notably, CMV PCR was also negative. However, based on inclusion bodies found in lung tissue transbronchial biopsy (TBLB), the diagnosis of CMV pneumonia was confirmed. Lung biopsy showed bronchiolitis obliterans organizing pneumonia (BOOP). Following ganciclovir and steroid treatment, he made a gradually recovery and was discharged seven days later. This case demonstrated that CMV pneumonia may associate with bronchiolitis obliterans organizing pneumonia in an immunocompetent patient.

Chronic and Asymptomatic Diffuse Alveolar Haemorrhage with Microscopic Polyangiitis: A Case Report and Review of the Literature.

Diffuse alveolar haemorrhage (DAH) is one of the major causes of death in microscopic polyangiitis (MPA) patients, because of acute respiratory failure with various respiratory symptoms. We, herein, present a case of chronic and asymptomatic DAH in a patient with MPA who was diagnosed by fibreoptic bronchoscopy. The patient showed localized reticular shadows, without any respiratory symptoms, and absence of inflammatory reactions, such as fever and CRP elevation, which is atypical for DAH. Three months after appearance of the lung abnormalities, DAH with MPA was diagnosed by fibreoptic bronchoscopy. She was initially treated with only corticosteroids and has thereafter been maintained with corticosteroids and azathioprine without relapse to date. We reviewed the literature for similar cases and opined that physicians should perform fibreoptic bronchoscopy in MPA patients with chronic lung abnormalities and anaemia to identify DAH, even if the patients show no respiratory symptoms and in the absence of inflammatory reactions.

Risk of Symptomatic Radiation Pneumonitis After Thoracic Radiation Therapy in Patients With a Reticular Shadow

Risk of Symptomatic Radiation Pneumonitis After Thoracic Radiation Therapy in Patients With a Reticular Shadow

High-dose corticosteroid therapy for erlotinib-induced interstitial lung disease in Japanese patient with advanced pancreatic cancer.

Erlotinib is a selective epidermal growth factor receptor tyrosine kinase inhibitor used as a target therapy against non-small lung cancer and advanced pancreatic cancer. A regimen of erlotinib plus gemcitabine has been proven to prolong overall survival in the patient with advanced pancreatic cancer. In addition to common adverse effects, such as diarrhea, mucositis and skin rash (acne form eruptions), acute interstitial lung disease (ILD) has been reported as an infrequent but potentially fatal complication. We here report a case of a Japanese patient with erlotinib-induced ILD in whom high-dose corticosteroid therapy was successful. A fifty-five-year-old male with cancer of the head of the pancreas with multiple liver metastases started treatment with gemcitabine plus erlotinib. On the 13th day of erlotinib treatment, he had high fever. Chest computed tomography (CT) scan showed a diffuse ground-glass like infiltration of both lungs. He was diagnosed with ILD, and high-dose corticosteroid therapy was started. Two weeks after the introduction of steroid therapy, the reticular shadow faded away on CT. He was successfully treated with corticosteroid for erlotinib-induced acute ILD although he died 6 months after the initiation of chemotherapy owing to disease progression. we showed a case of a successfully treated Japanese patient of erlotinib-induced ILD. Because erlotinib-induced ILD would frequently occur in Japanese patients, closer attention to ILD should be paid for Japanese patients than in Western populations. If erlotinib-induced ILD occurs, a high-dose corticosteroid therapy would be a useful option of treatment.

Dendriform pulmonary ossification visualised by scanning acoustic microscope

A 45-year-old man was referred to our facility because of an abnormal shadow on chest radiography. CT revealed a reticular and nodular shadow (figure 1). Histopathology of a surgical lung...

Pulmonary Langerhans Cell Histiocytosis

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare disease with insidious onset and nonspecific manifestations. The objective of this article was to characterize the clinical manifestations and features of PLCH by retrospectively analyzing clinical data of patients with PLCH in addition to simultaneous review of literature.A retrospective analysis was conducted on clinical data of patients with PLCH (n = 7), whose conditions were diagnosed by biopsy from pulmonary tissue (n = 6) or enlarged lymph nodes in the neck (n = 1) and confirmed by PLCH typical radiological features on computed tomography (CT) scan, between January 2001 and September 2012 at the Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. The review of published reports was made to further emphasize the clinical manifestation and radiological features of PLCH.Long history of cigarette smoking was found in 6 patients. Two patients had recurrent pneumothorax and the other 2 had pulmonary arterial hypertension (World Health Organization group 5 pulmonary hypertension), diagnosed through ultrasonic cardiogram. The nodular shadows were revealed by chest CT scan in 5 patients, cystic shadows in 5 patients, and reticular shadows in 2 patients, as major manifestations, respectively; most of the lesions were located in the middle or upper segments of the lung. The obvious shrank of lesion was found in 1 patient after completely quitting smoking.The pathogenesis of PLCH might be closely associated with smoking. The cystic or nodular lesion was the typical radiological features. Further prospective studies with large sample size are required to further validate the study results and understand the clinical characteristics of PLCH to avoid misdiagnosis.

Hard Metal Lung Disease Diagnosed on a Transbronchial Lung Biopsy Following Recurrent Contact Dermatitis

A 63-year-old man employed in a hard metal manufacturing company for 40 years presented with a chronic dry cough and exertional dyspnea 20 years after the onset of recurrent exanthemas. A chest radiograph revealed bilateral reticular shadows in the upper lung field. Pathological specimens in which tungsten was detected were obtained via a transbronchial lung biopsy. Patch tests were positive for cobalt and other metals. The patient was diagnosed with hard metal lung disease (HMLD) concurrent with contact dermatitis and treated with corticosteroids. This case suggests that allergies to metal may play a role in the onset of HMLD.