- [A CASE OF SUMMER-TYPE HYPERSENSITIVITY PNEUMONITIS ACCOMPANIED BY THE SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE]. [Journal Article]
- AArerugi 2018; 67(1):62-66
- A 47-year old man presented to our hospital with a 6-month history of malaise, cough and dyspnea on exertion. Laboratory testing revealed the severe hyponatremia. A chest X-ray showed bilateral diffu...
A 47-year old man presented to our hospital with a 6-month history of malaise, cough and dyspnea on exertion. Laboratory testing revealed the severe hyponatremia. A chest X-ray showed bilateral diffuse micronodules. Anti-Trichosporon asahii antibody and environmental provocation test were positive. Bronchoalveolar lavage fluid showed lymphocytosis and low CD4/8 ratio. The specimens obtained by transbronchial lung biopsy revealed alveolitis. Based on these findings, the patient was diagnosed as having summer-type hypersensitivity pneumonitis (SHP). The patient was treated with antigen avoidance and oral corticosteroid. The hyponatremia caused by syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was treated with normal saline and water restriction. Serum sodium level was improved with treatment of SHP, which suggested the relevance between SHP and SIADH.
- Chronic interstitial lung disease in children. [Review]
- EREur Respir Rev 2018 Mar 31; 27(147)
- Children's interstitial lung diseases (chILD) are increasingly recognised and contain many lung developmental and genetic disorders not yet identified in adult pneumology. Worldwide, several register...
Children's interstitial lung diseases (chILD) are increasingly recognised and contain many lung developmental and genetic disorders not yet identified in adult pneumology. Worldwide, several registers have been established. The Australasian Registry Network for Orphan Lung Disease (ARNOLD) has identified problems in estimating rare disease prevalence; focusing on chILD in immunocompetent patients, a period prevalence of 1.5 cases per million children and a mortality rate of 7% were determined. The chILD-EU register highlighted the workload to be covered per patient included and provided protocols for diagnosis and initial treatment, similar to the United States chILD network. Whereas case reports may be useful for young physicians to practise writing articles, cohorts of patients can catapult progress, as demonstrated by recent studies on persistent tachypnoea of infancy, hypersensitivity pneumonitis in children and interstitial lung disease related to interferonopathies from mutations in transmembrane protein 173. Translational research has linked heterozygous mutations in the ABCA3 transporter to an increased risk of interstitial lung diseases, not only in neonates, but also in older children and adults. For surfactant dysfunction disorders in infancy and early childhood, lung transplantation was reported to be as successful as in adult patients. Mutual potentiation of paediatric and adult pneumologists is mandatory in this rapidly extending field for successful future development.This brief review highlights publications in the field of paediatric interstitial lung disease as reviewed during the Clinical Year in Review session presented at the 2017 European Respiratory Society (ERS) Annual Congress in Milan, Italy. It was commissioned by the ERS and critically presents progress made as well as drawbacks.
- Spectrum of interstitial lung diseases at a tertiary center in a developing country: A study of 803 subjects. [Journal Article]
- PlosPLoS One 2018; 13(2):e0191938
- CONCLUSIONS: Sarcoidosis, IPF and CTD-ILDs were the most common ILDs seen at a tertiary center in northern India similar to the spectrum reported from developed countries. More studies are required from developing countries to ascertain the spectrum of ILDs in different geographic locales.
- Comprehensive analysis of immune, extracellular matrices and pathogens profile in lung granulomatosis of unexplained etiology. [Journal Article]
- HPHum Pathol 2018 Feb 02
- This study analyzed the Type 1 and Type 2T helper (Th-1/Th-2) cytokines (including interleukins), immune cellular, matrix profile and pathogens in granulomas with unexplained etiology and compared to...
This study analyzed the Type 1 and Type 2T helper (Th-1/Th-2) cytokines (including interleukins), immune cellular, matrix profile and pathogens in granulomas with unexplained etiology and compared to infectious and non-infectious etiology. Surgical lung biopsies from 108 patients were retrospectively reviewed. Histochemistry, immunohistochemistry, immunofluorescence, morphometry and polymerase chain reaction (PCR) were employed, respectively, to evaluate total collagen and elastin fibers, collagen I and III, immune cells, cytokines, metalloproteinase-9 (MMP-9), myofibroblasts and multiple usual and unusual pathogens. No relevant PCR expression was found for in unexplained granulomas. A significant difference was found between the absolute number of eosinophils, macrophages and lymphocytes within granulomas compared to uninvolved lung tissue. Granulomas with unexplained etiology (UEG) presented increased number of eosinophils, high expression of interleukins (IL) IL-4/L-5 and transformer growth factor beta (TGF-β). In sarcoidosis, CD4/CD8 cell number was significantly higher within and outside granulomas, respectively; the opposite was detected in hypersensitivity pneumonitis. Again, a significant difference was found between the high number of myofibroblasts and MMP-9 in UEG, hypersensitivity pneumonitis and sarcoidosis compared to granulomas of tuberculosis. Granulomas of paracoccidioisis exhibited increased type I collagen and elastic fibers. Th1 immune cellular profile was similar among granulomas with unexplained etiology, infectious and non-infectious. In contrast, modulation of Th2 and matrix remodeling was associated with more fibroelastogenesis and scarring of lung tissue in UEG compared to infectious and non-infectious. We concluded that IL-4/IL-5 and TGF-β might be employed as surrogate markers of early fibrosis subsiding the need for genotyping, and promise therapeutic target in unexplained granulomas.
- Desvenlafaxine-Induced Interstitial Pneumonitis: A Case Report. [Journal Article]
- DSDrug Saf Case Rep 2018 Jan 17; 5(1):5
- A 52-year-old man developed interstitial pneumonitis during treatment with desvenlafaxine for major depressive disorder. The man received desvenlafaxine at 50 mg for symptoms of depression 4 years ea...
A 52-year-old man developed interstitial pneumonitis during treatment with desvenlafaxine for major depressive disorder. The man received desvenlafaxine at 50 mg for symptoms of depression 4 years earlier. Six months after a dose increase to 100 mg, he developed bronchitic symptoms with mild, persistent dyspnea. Investigations revealed a restrictive pattern on pulmonary function testing, bilateral upper lobe reticular opacities with traction bronchiectasis on radiology imaging, and end-stage interstitial fibrosis with honeycomb changes consistent with chronic hypersensitivity pneumonitis on open lung biopsy. He was diagnosed with drug-induced interstitial pneumonitis. Desvenlafaxine was discontinued and the patient received prednisone and mycophenolate mofetil. The patient had subsequent stability in the progression of his pulmonary disease after 1 month. After 1 year of drug discontinuation and treatment, his disease process remained, but without major progression. A Naranjo assessment score of 4 was obtained, indicating a possible relationship between the patient's adverse drug reaction and his use of the suspect drug.
- Is It Idiopathic Pulmonary Fibrosis or Not? [Review]
- JAJ Am Board Fam Med 2018 Jan-Feb; 31(1):151-162
- Pulmonary fibrosis is not uncommon. Usual interstitial pneumonitis (UIP)/idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic pulmonary fibrotic diseases and has the worst prognos...
Pulmonary fibrosis is not uncommon. Usual interstitial pneumonitis (UIP)/idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic pulmonary fibrotic diseases and has the worst prognosis with a mean life expectancy of 3.8 years. The American Thoracic Society has provided guidelines for the accurate diagnosis of IPF.In 2014, 2 antifibrotic medications were approved in the United States that target the multiple fibrotic pathways of UIP, which increased the need for early and accurate diagnosis of IPF. The early and correct diagnosis is hampered by mimickers that include nonspecific interstitial pneumonitis, chronic hypersensitivity pneumonitis, and fibrotic sarcoidosis. Careful history taking, serologic testing, and Computer Tomography (CT) inspection can frequently make the correct diagnosis without need of invasive procedure. The purpose of this article is to share the most important aspects of the clinical and radiology presentation of IPF and its mimickers to enhance primary care clinician's ability to correctly and noninvasively diagnose UIP/IPF.
- Gender-related aspects in occupational allergies - Secondary publication and update. [Review]
- WAWorld Allergy Organ J 2017; 10(1):44
- For years occupational allergies have been among the most frequently recorded occupational diseases, and both the skin as well as the respiratory tract may be affected. An estimated 9 to 15% of adult...
For years occupational allergies have been among the most frequently recorded occupational diseases, and both the skin as well as the respiratory tract may be affected. An estimated 9 to 15% of adult asthma is (partially) caused by work-related exposure. Gender-specific differences in exposure cause different risks in the workplace which affect the health of employees. This also applies to exposure and working conditions when handling sensitizing working substances. The presented gender-specific analysis of the German documentation of confirmed occupational respiratory allergic diseases and occupational skin diseases reveals clear differences between men and women in the number of diseases and also in exposure conditions and working areas.
- Chirping Rales in Hypersensitivity Pneumonitis. [Letter]
- ChestChest 2018; 153(1):290
- [Extrinsic allergic alveolitis: minimum for clinical practice]. [Journal Article]
- VLVnitr Lek 2018; 63(11):802-806
- Extrinsic allergic alveolitis (EAA) represent a group of diseases, that develop in susceptible individuals after repeated exposure to usually organic inhalation antigen. Patient may be in contact wit...
Extrinsic allergic alveolitis (EAA) represent a group of diseases, that develop in susceptible individuals after repeated exposure to usually organic inhalation antigen. Patient may be in contact with these agents both in occupational and in home environment, as well as during free time activities and hobbies. The course of the disease is highly variable - EAA may have dramatic symptoms with fever, cough and severe dyspnoea as well as may be presented with slowly increasing dyspnoea and chronic cough. The more inconspicious are the symptoms of chronic EAA, the more problematic its treatment may be. Treatment options must be sought individually and respect potential risks and benefits for the patient. Avoiding further contact with offending antigens as well as optimizing patients nutritional status and starting pulmonary rehabilitation should be emphasized.Key words: corticosteroids - extrinsic allergic alveolitis - environmental exposure.
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- An onion farmer with a case of hypersensitivity pneumonitis caused by Aspergillus niger. [Journal Article]
- RMRespir Med Case Rep 2018; 23:60-62
- A 62-year old man was admitted to our hospital with a 2-week complaint of a dry cough, general fatigue, and dyspnea on effort. He has been an onion farmer for several years and developed these sympto...
A 62-year old man was admitted to our hospital with a 2-week complaint of a dry cough, general fatigue, and dyspnea on effort. He has been an onion farmer for several years and developed these symptoms after cleaning up onion peels with air compressors. A chest roentgenogram and computed tomography showed a ground glass shadow in the bilateral upper lung field. Cellular analysis of the bronchoalveolar lavage fluid showed elevated total cell numbers and lymphocytes. Transbronchial lung biopsies revealed a non-caseating granuloma with both epithelioid cells and Langhans giant cells. After the admission, these symptoms and radiological findings gradually improved without any treatment. Then, a returning-home provocation test was positive only when he worked cleaning up onion peels with air compressors. A. niger was cultured from his workplace and black mold from the onion peels. The precipitation antibody and the antigen were both positive for Aspergillus. Therefore, we diagnosed this case as hypersensitivity pneumonitis caused by inhalation of A. niger. Although hypersensitivity pneumonia caused by A. niger is rare, physicians should aware the possibility of this condition in farmers because A niger is ubiquitously present in several vegetables and fruits.