急性纤维素性并机化性肺炎一例及文献复习

目的 提高对急性纤维素性并机化性肺炎(AFOP)临床与病理特点的认识.方法 分析2009年12月收治的1例AFOP患者临床资料及诊治经过,并复习相关文献.结果患者男,73岁,临床表现为发热、咳嗽、咳少量白痰,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.经抗生素及抗真菌治疗无效,呼吸困难加重,胸部CT示双肺团片状影和结节影增多.B超引导下经皮肺穿刺活检病理表现为肺泡间隔略增宽,可见淋巴细胞和浆细胞浸润,肺泡腔内可见纤维母细胞呈息肉状延伸(机化)伴纤维素样红染物质,未见中性粒细胞和嗜酸粒细胞浸润,病变符合AFOP.经糖皮质激素治疗后症状很快缓解,胸部影像学改变明显好转.本例的临床特征与文献报道的AFOP亚急性型相一致.结论 AFOP的临床特征缺乏特异性,主要呈急性肺损伤的临床表现,确立诊断主要依赖组织病理学检查.目前尚无统一的治疗方案,糖皮质激素是主要治疗措施,但其剂最和疗程也未明确,且在糖皮质激素治疗减量的过程中还有复发的可能.     

Early assessment of rapidly progressive interstitial pneumonia associated with amyopathic dermatomyositis

Amyopathic dermatomyositis (ADM) is occasionally complicated by rapidly progressive interstitial pneumonia (RPIP), and in such cases, diffuse alveolar damage (DAD) is usually diagnosed at autopsy. Here, we present three patients with RPIP accompanied by ADM in whom lung disease was assessed at an early stage. High-resolution computed tomography (HRCT) carried out before the onset of dyspnoea revealed uniformly subpleural reticular opacity with faint ground-glass attenuation. At that stage, surgical lung biopsies from two patients showed histological patterns typical of cellular nonspecific interstitial pneumonia (NSIP). Despite pulse methylprednisolone and subsequent high-dose oral administration of prednisolone, lung disease progressed in all patients, with extensive areas of ground-glass opacity and consolidation observed in HRCT scans. DAD was confirmed histologically in one case. Additional administration of cyclosporine, pulse cyclophosphamide or high-dose intravenous administration of immunoglobulin rescued all patients. Our data suggest that ADM-associated interstitial pneumonia takes an aggressive course even when the radiological and histological features are consistent with NSIP. Aggressive combination therapy with high-dose steroids and immunosuppressive agents is required as early as possible for patients with this life-threatening disorder.     

Organizing pneumonia secondary to influenza infection: Two case reports and a literature review

BackgroundOrganizing pneumonia (OP) is a rare complication of influenza virus infection but scarce data are available. The recognition of this entity is important because require appropriate treatment.MethodsWe report two cases and perform a systematic review on PubMed database. Only cases with histological confirmation of OP and influenza virus positive laboratory test were included.ResultsWe collected 16 patients. Median age was 52 year, 20% of patients were smokers and 43.8% had not any comorbidity. Influenza A virus infection was diagnosed in 75%. Clinical manifestation consisted on a respiratory deterioration with a median time of appearance of 14 days. Radiological pattern observed was ground-glass opacities with consolidations. Survival was observed in 12 patients (75%). All three patients who did not receive steroid treatment died.ConclusionPhysicians must be aware that patients with influenza infection with a torpid course could be developing OP and prompt corticoid therapy should be instaured.     

咳嗽伴呼吸困难2个月

目的 通过病例讨论的方式提高对隐原性机化性肺炎(cryptogenic organising pneumonia,COP)的认识.方法 结合我院收治的一例COP病例的临床资料、病例讨论发言记录及对相关文献进行分析.结果 患者女,66岁,表现为干咳及进行性加重的活动后呼吸困难,胸部CT示两肺多发病灶(两下肺明显),位于胸膜下,磨玻璃样改变,部分实变.反复细菌培养未发现致病菌,自身抗体、血管炎,免疫球蛋白系列,补体C3及C4、类风湿因子均未见异常,结合病理结果及临床排除其他明确的致病原(如感染)或其他伴随疾病(如结缔组织疾病)后,诊断COP,经激素治疗后恢复良好.结论 COP的临床表现不典型,容易误诊,需结合临床、影像学特征及病理表现,除外已知因素后作出诊断,是一个综合判断的过程.     

Advanced gallbladder cancer accompanied with cancer-associated dermatomyositis: A case report and literature review

Rationale:Muscle weakness due to cancer-associated dermatomyositis (CADM) can be misdiagnosed as cancer cachexia and disuse atrophy.Patient concerns:A 75-year-old female was admitted to our institute with muscle weakness, dysphagia, and suspected gallbladder cancer. Computed tomography and cytopathological examinations of the liver biopsy and fine-needle aspiration from swollen lymph nodes using endoscopic ultrasonography revealed cancer in the gallbladder body and metastasis to the lymph nodes around the abdominal aorta. We avoided the administration of anticancer drugs due to her poor general condition.Diagnosis:Subsequently, we diagnosed her with muscle weakness and dysphagia as a result of CADM using species from muscle and skin biopsy.Interventions and Outcomes:Prednisolone therapy and anticancer agents partially improved the patient symptoms.Lessons:CADM is reported to be associated with a high incidence of dysphagia, which may aid in the diagnosis of this disease.     

Pneumomediastinum in dermatomyositis itself is not a poor prognostic factor: report of a case and review of the literature

We describe a 38-year-old man who presented with proximal muscle weakness, myalgia, polyarthralgia, and skin rash and was diagnosed as having dermatomyositis (DM). The patient's symptoms improved with prednisolone therapy. However, myopathy relapsed and pneumomediastinum with subcutaneous emphysema developed. Pneumomediastinum with subcutaneous emphysema rapidly disappeared by the administration of ciclosporin. We reviewed the present case and previously reported cases regarding the clinical characteristics. All of the reported death cases were accompanied by interstitial lung disease (ILD). Although it has been reported that pneumomediastinum in DM can be fatal, the direct cause of patient's death was due to respiratory failure resulting from progressive ILD. Pneumomediastinum without ILD shows a good prognosis.     

A case of polymyositis complicated with organizing pneumonia: case report and literature review

A 54-year-old man was admitted to hospital with fever, dyspnea, and polyarthralgia. A chest radiograph showed consolidations in the bilateral lungs, and histological examination of transbronchial lung biopsy samples revealed organizing pneumonia. He was also diagnosed with polymyositis because of muscle weakness, elevated muscle enzymes, myogenic findings on the electromyogram, and a positive test for the anti-Jo-1 antibody. Herein, we review 25 cases of organizing pneumonia with polymyositis/dermatomyositis with respect to their clinical features and treatment.     

A case of polymyositis complicated with organizing pneumonia: case report and literature review

Abstract

A 54-year-old man was admitted to hospital with fever, dyspnea, and polyarthralgia. A chest radiograph showed consolidations in the bilateral lungs, and histological examination of transbronchial lung biopsy samples revealed organizing pneumonia. He was also diagnosed with polymyositis because of muscle weakness, elevated muscle enzymes, myogenic findings on the electromyogram, and a positive test for the anti-Jo-1 antibody. Herein, we review 25 cases of organizing pneumonia with polymyositis/dermatomyositis with respect to their clinical features and treatment.     

误诊为真菌性肺炎的保乳术后放疗诱导的闭塞性细支气管炎伴机化性肺炎综合征1例并文献复习

目的 探讨放射治疗诱导的闭塞性细支气管炎伴机化性肺炎(BOOP)的临床表现、影像学特征、危险因素及治疗.方法 分析1例确诊为乳腺癌保乳术并放疗后引起的放疗诱导的BOOP综合征患者的临床特点,并结合文献进行复习.结果 乳腺癌放疗后引起的放疗诱导的BOOP综合征多发生在乳腺癌保乳手术后放化疗并进行内分泌治疗的患者中,发病率低,50岁以上女性多见,多发生在乳腺癌放疗后12个月内,发热或呼吸道症状超过2周,胸部CT或X线胸片提示放疗区域外的肺部浸润影,同时排除其他发病原因时需考虑该病.确诊需要依靠病理,若病灶进展则考虑用激素治疗.结论 对于发热合并肺内浸润影的保乳术并放疗后患者,除考虑宿主免疫功能下降引起的真菌性肺炎、结核及非常见病原体引起的感染性病变外,还需考虑非感染性病变.经验治疗无好转时,仍需考虑胸腔下肺活检,同时仍应慎重使用激素.     

Kikuchi Fujimoto disease associated with cryptogenic organizing pneumonia: case report and literature review

Background  

The association of Kikuchi Fujimoto disease (KFD) with cryptogenic organizing pneumonia (COP) is extremely rare. We report a case of simultaneous diagnosis of KFD and COP.     

1例误诊为肺栓塞的局灶性机化性肺炎并文献复习

目的 探讨局灶性机化性肺炎的临床特征、鉴别诊断及治疗.方法 分析就诊于上海交通大学医学院附属新华医院呼吸科的1例经肺活检病理明确的局灶性机化性肺炎患者的临床资料,并结合文献进行复习.结果 局灶性机化性肺炎发病率低,可有咳嗽、咯痰、咯血、胸痛、发热等多种临床表现,影像学上缺乏特异性,主要表现为孤立的局限性病灶.明确诊断主要依靠病理.治疗则以应用糖皮质激素为主.结论 局灶性机化性肺炎实际是肺部病变的一种病理状态,它多由肺内感染性疾病等多种因素导致肺部改变的一种共同表现,其表现常需与周围型肺癌鉴别,有时也可出现类似肺栓塞的表现,需要临床综合分析做出判断.     

Pneumomediastinum,subcutaneous emphysema,and pneumothorax after a pulmonary function testing in a patient with bleomycin-induced interstitial pneumonitis

Spontaneous pneumomediastinum is an uncommon event, the clinical picture of which includes retrosternal chest pain, subcutaneous emphysema, dyspnea, and dysphonia. The pathophysiological mechanism involved is the emergence of a pressure gradient between the alveoli and surrounding structures, causing alveolar rupture with subsequent dissection of the peribronchovascular sheath and infiltration of the mediastinum and subcutaneous tissue with air. Known triggers include acute exacerbations of asthma and situations that require the Valsalva maneuver. We described and documented with HRCT scans the occurrence of pneumomediastinum after a patient with bleomycin-induced interstitial lung disease underwent pulmonary function testing. Although uncommon, the association between pulmonary function testing and air leak syndromes has been increasingly reported in the literature, and lung diseases, such as interstitial lung diseases, include structural changes that facilitate the occurrence of this complication.     

无肌炎性皮肌炎引起急性肺间质病变2例并文献复习

目的提高对无肌炎性皮肌炎引起的急性肺间质病变（ADM—ILD）的临床表现诊断及治疗的认识。方法报道1例死亡及1例成功救治的无肌炎性皮肌炎引起的急性肺间质病变,并结合国内文献报道35例ADM—ILD患者的临床资料进行分析。结果临床上表现为胸闷、气促、干咳、发热、进行性呼吸困难、紫绀,并很快到严重的低氧血症和呼吸衰竭,高分辨率CT有很大的诊断价值。治疗效果欠佳。结论无肌炎性皮肌炎引起的急性肺间质病变死亡率很高,临床治疗过程中应该引起重视。     

A simultaneous onset of organizing pneumonia and rheumatoid arthritis, along with a review of the literature

Organizing pneumonia (OP) is a specific type of interstitial pneumonia that has been noted as one of the pulmonary manifestations during the course of rheumatoid arthritis (RA). In this study, we report a case with a simultaneous development of OP and RA. The patient presented with concurrent flu-like symptoms and arthralgia of multiple joints, and antibiotic therapy was not effective. The rheumatoid factor (RF) and anti-cyclic citrullinated antibodies were both high. Multiple air-space opacities on chest radiographs and bilateral peripheral consolidations on high-resolution computed tomography films were evident. The histology of transbronchial lung biopsy samples was characterized by intra-alveolar buds of granulation tissue consisting of intermixed myofibroblasts and connective tissues. Treatment with prednisolone induced a complete recovery from OP without relapses. Our review of previous reports about RA-associated OP (RA-OP) suggested that the high titer of RF and increased disease activity of RA indicate a great risk of developing OP. This condition may represent a lung’s reaction in the RA-associated inflammatory and/or immune process. We should be aware of RA-OP cases in which pulmonary manifestations precede articular symptoms. In these cases, respiratory manifestations are the main evidence of RA activity. In most cases of steroid-resistant RA-OP, the use of immunosuppressants was effective. Since OP may progress to fibrotic lung disease during the course of RA, we may consider performing a second lung biopsy for steroid-resistant patients, even if they have once been diagnosed as OP.     

Possible relationship between organizing pneumonia and chronic pulmonary aspergillosis: A case report and literature review

Organizing pneumonia (OP) is a nonspecific response to various forms of lung injury and has been reported in association with several infectious agents. However, little is known about the relationship between OP and chronic pulmonary aspergillosis, and the mechanism of this linkage has not been elucidated. Here, we present a case of chronic pulmonary aspergillosis that led to the development of OP, which was successfully treated with corticosteroid and surgical intervention. In a review of the literature, we aim to highlight the possible relationship between OP and chronic pulmonary aspergillosis.     

Early diagnosis and treatment for remission of clinically amyopathic dermatomyositis complicated by rapid progress interstitial lung disease: a report of two cases

We report two cases of clinically amyopathic dermatomyositis (CADM) complicated by rapid progress interstitial lung disease (RPILD). The diagnosis of CADM was based on Gottron’s papule and RPILD, and the absence of muscle weakness. The female patients were treated with early immunosuppressive therapies including steroid pulse therapy, resulting in significant improvement in respiratory symptoms, clinical data, and imaging. Measurement of anti-CADM-140/MDA5 antibody was useful for obtaining a definitive diagnosis of CADM in these cases.     

Pulmonary tuberculosis associated acute fibrinous and organizing pneumonia: A case report and literature review

Background

Acute fibrinous and organizing pneumonia (AFOP) is a rare histological interstitial pneumonia pattern characterized by patches of “fibrin balls” distributed within the alveoli and organizing pneumonia. Currently, there is no consensus on the diagnosis and treatment of this disease.

Methods

We present the case of a 44-year-old male with AFOP secondary to Mycobacterium tuberculosis. We have further reviewed organizing pneumonia (OP) and AFOP caused by tuberculosis.

Conclusion

Tuberculosis secondary to OP or AFOP is rare and challenging to diagnose. We need to constantly adjust the treatment plan based on the patient's symptoms, test results, and response to treatment in order to arrive at an accurate diagnosis and maximize treatment efficacy.     

Persistent pneumomediastinum and dermatomyositis: a case report and review of the literature

We describe a 42-year-old man with dermatomyositis and interstitial lung disease who presented with anterior neck pain and dyspnoea. Chest radiographs showed subcutaneous emphysema, pneumomediastinum and diffuse reticulonodular infiltration in both lungs. After the administration of high doses of prednisolone, an improvement of pulmonary function and respiratory symptoms was observed but the pneumomediastinum persists 12 months after diagnosis, and without any complication. We review the cases that have been reported thus far of pneumomediastinum associated with dermatomyositis and discuss the possible mechanisms involved. We conclude that pneumomediastinum is not an uncommon complication of dermatomyositis and that its aetiopathogenesis remains very unclear. Received: 26 July 2000 / Accepted: 14 March 2001