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Herbst JB, Myers JL. Hypersensitivity pneumonia: role of surgical lung biopsy. Arch Pathol Lab Med 2012; 136:889-95. [PMID: 22849736 DOI: 10.5858/arpa.2012-0201-cr] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung biopsy often plays a key role in identifying patients with hypersensitivity pneumonia, especially in the absence of a typical history. A 69-year-old woman with a 2-year history of unexplained dyspnea on exertion underwent surgical lung biopsy for diagnosis of diffuse lung disease thought to represent idiopathic pulmonary fibrosis. Her biopsy showed honeycomb change and fibroblast foci suggestive of usual interstitial pneumonia, but also showed areas of cellular interstitial pneumonia with chronic bronchiolitis and a pattern of granulomatous inflammation typical of hypersensitivity pneumonia. The classic features of hypersensitivity pneumonia in surgical lung biopsy are emphasized, including a bronchiolocentric cellular interstitial pneumonia, chronic bronchiolitis, and poorly formed nonnecrotizing granulomas. As illustrated in our patient, sometimes subtle histologic clues are key in separating hypersensitivity pneumonia from usual interstitial pneumonia and other forms of idiopathic interstitial pneumonia. Making the distinction is important given differences in treatment strategies and natural history.
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Affiliation(s)
- Jonathon B Herbst
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109-5054, USA.
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Chronic hypersensitivity pneumonitis: high resolution computed tomography patterns and pulmonary function indices as prognostic determinants. Eur Radiol 2012; 22:1672-9. [DOI: 10.1007/s00330-012-2427-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/18/2012] [Accepted: 02/03/2012] [Indexed: 12/20/2022]
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103
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Ampere A, Delhaes L, Soots J, Bart F, Wallaert B. Hypersensitivity pneumonitis induced by Shiitake mushroom spores. Med Mycol 2012; 50:654-7. [PMID: 22329454 DOI: 10.3109/13693786.2012.658091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is a pulmonary granulomatosis involving an immunoallergic mechanism caused by chronic inhalation of antigens, most frequently organic substances, as well as chemicals. We report the first European case of hypersensitivity pneumonitis due to the inhalation of Shiitake mushroom spores. A 37-year-old French Caucasian man with a one-month history of persistent dry cough, shortness of breath and loss of weight was admitted to our hospital on December 2010. Anamnesis showed he was involved in mushroom production beginning in the summer of 2010. His temperature on admission was 36.6°C and he had a normal blood pressure (135/90 mmHg). Bilateral fine crackles were audible in the base of both lungs. Pulmonary function tests showed a mild restrictive pattern with decreased DLco and a PaO(2) of 65 mmHg, Chest CT scan revealed reticulo-nodular shadows, slight ground glass opacities, liner atelectasis, and subpleural opacities in both lung fields. Bronchoscopy was normal but cytological examination of BAL revealed a predominant lymphocytosis (55%). Serum precipitins to the Shiitake mushroom spores were positive (3 precipitins arcs with high intensity) and as a result we advised the patient to cease his mushroom production activities. The diagnosis of hypersensitivity pneumonitis due to inhalation of Shiitake mushroom spores was established as a result of the improvement of all of his clinical symptoms, i.e., cough, weight loss, bilateral fine crackles, mild restrictive pattern of pulmonary function, and reticulo-nodular shadows on chest CT, once exposure was eliminated. Recent interest in exotic mushrooms varieties, e.g., Shiitake, in developed countries because of their possible medicinal properties might increase the potential risk of HP among mushrooms workers. Therefore, healthcare professionals have to take this new potential respiratory disease into account.
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Affiliation(s)
- Alexandre Ampere
- Service de Pneumologie, Centre Hospitalier Béthune, Lille, France
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Myers JL. Hypersensitivity pneumonia: the role of lung biopsy in diagnosis and management. Mod Pathol 2012; 25 Suppl 1:S58-67. [PMID: 22214971 DOI: 10.1038/modpathol.2011.152] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hypersensitivity pneumonia is a form of diffuse interstitial lung disease resulting from sensitization to an inhaled antigen. Clinical and radiological features are relatively nonspecific, overlapping significantly with other forms of diffuse interstitial lung disease. Establishing the diagnosis in the absence of lung biopsy is challenging and is heavily dependent on being able to identify a specific antigenic exposure. Lung biopsy is especially important in diagnosing hypersensitivity pneumonia in patients for whom no incriminating exposure has been elucidated. Surgical lung biopsies show a classical combination of findings in the majority of patients, which include an airway-centered, variably cellular chronic interstitial pneumonia, a lymphocyte-rich chronic bronchiolitis, and poorly formed non-necrotizing granulomas distributed mainly within the peribronchiolar interstitium. The bronchiolitis may include variable degrees of peribronchiolar fibrosis and hyperplasia of the bronchiolar epithelium ('peribronchiolar metaplasia'), a characteristic but a nonspecific finding. In some patients, granulomatous inflammation may be lacking, resulting in a histological appearance resembling nonspecific interstitial pneumonia. Late-stage fibrotic hypersensitivity pneumonia results in clinical, radiological, and histological findings that closely mimic usual interstitial pneumonia. The presence of established collagen fibrosis, especially when associated with architectural distortion in the form of honeycomb change, is associated with shorter survivals.
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Affiliation(s)
- Jeffrey L Myers
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109-5054, USA.
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105
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Lacout A, Marcy PY, Ngo TM, El Hajjam M. Multidetector row CT scan in hypersensitivity pneumonitis: Contribution of minimum intensity projection reformation. J Med Imaging Radiat Oncol 2011; 55:291-5. [DOI: 10.1111/j.1754-9485.2011.02267.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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107
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Harari S, Torre O, Moss J. Lymphangioleiomyomatosis: what do we know and what are we looking for? Eur Respir Rev 2011; 20:34-44. [PMID: 21357890 PMCID: PMC3386525 DOI: 10.1183/09059180.00011010] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease characterised by proliferation of abnormal smooth muscle-like cells (LAM cells) leading to progressive cystic destruction of the lung, lymphatic abnormalities and abdominal tumours. It affects predominantly females and can occur sporadically or in patients with tuberous sclerosis complex. This review describes the recent progress in our understanding of the molecular pathogenesis of the disease and LAM cell biology. It also summarises current therapeutic approaches and the most promising areas of research for future therapeutic strategies.
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Affiliation(s)
- S. Harari
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria – Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Milan, Italy. Translational Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.,S. Harari, Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Ospedale San Giuseppe, via San Vittore 12, 20123 Milan, Italy. E-mail:
| | - O. Torre
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria – Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Milan, Italy. Translational Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J. Moss
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria – Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Milan, Italy. Translational Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Ansótegui Barrera E, Mancheño Franch N, Vera-Sempere F, Padilla Alarcón J. Lymphangioleiomyomatosis. Arch Bronconeumol 2011; 47:85-93. [PMID: 21255897 DOI: 10.1016/j.arbres.2010.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/02/2010] [Accepted: 08/07/2010] [Indexed: 12/28/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease that mainly affects women, particularly at fertile age. It is sporadic or associated with tuberous sclerosis complex. It is characterised by an abnormal proliferation of immature smooth muscle cells (SMC), which grow aberrantly in the airway, parenchyma, lymphatics and pulmonary blood vessels and which can gradually lead to respiratory failure. It affects several systems, affecting the lymphatic ganglia and causing abdominal tumours. Given its very low prevalence, a difficult to establish early diagnosis, absence of curative treatment and the difficulty in obtaining information, places LAM under the heading of the so-called Rare Diseases. There is a growing interest in the study of this disease which has led to the setting up of patient registers and an exponential growth in LAM research, both at a clinical level and cellular level.
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109
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Maffessanti M, Dalpiaz G. Computed Tomography of Diffuse Lung Diseases and Solitary Pulmonary Nodules. PRACTICAL PULMONARY PATHOLOGY: A DIAGNOSTIC APPROACH 2011:27-89. [DOI: 10.1016/b978-1-4160-5770-3.00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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110
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VERMA H, NICHOLSON AG, KERR KM, DEMPSEY OJ, GIBBS AR, CAMPBELL I, BLACK F, RASSL D, RICE AJ, RENZONI EA, WELLS AU, HANSELL DM. Alveolar proteinosis with hypersensitivity pneumonitis: A new clinical phenotype. Respirology 2010; 15:1197-202. [DOI: 10.1111/j.1440-1843.2010.01848.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Franks TJ, Galvin JR. Hypersensitivity Pneumonitis: Essential Radiologic and Pathologic Findings. Surg Pathol Clin 2010; 3:187-98. [PMID: 26839033 DOI: 10.1016/j.path.2010.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hypersensitivity pneumonitis is a diffuse, granulomatous interstitial lung disease caused by repeated exposure to a wide spectrum of environmental antigens. Clinical, radiologic, and histologic findings are quite variable and mimic many other diseases; therefore, diagnosis depends on a constellation of findings rather than a single defining feature. High-resolution computed tomography (HRCT) plays a critical role in this setting. The presence of centrilobular nodules, multifocal ground glass opacities, and evidence of air trapping in the expiratory phase of respiration is highly suggestive of hypersensitivity pneumonitis and can direct clinicians to the correct diagnosis. For the pathologist, typical HRCT findings not only corroborate the diagnosis of hypersensitivity pneumonitis when the characteristic triad of airway-centered chronic interstitial inflammation, interstitial poorly formed non-necrotizing granulomas, and organizing pneumonia is present on biopsy, but also improve diagnostic confidence in biopsies lacking components of the diagnostic histologic triad. Importantly, the presence of focal or unilateral imaging findings should prompt a careful search by the pathologist for an infectious etiology, thus avoiding errors in determining the significance of granulomas on biopsy. This article reviews the essential radiologic and pathologic findings in hypersensitivity pneumonitis, discusses the primary considerations in the differential diagnosis, and offers an approach to biopsy evaluation.
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Affiliation(s)
- Teri J Franks
- Department of Pulmonary & Mediastinal Pathology, Armed Forces Institute of Pathology, 6825 16th Street NW, Washington, DC 20306, USA.
| | - Jeffrey R Galvin
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th Street NW, Washington, DC 20306, USA; Department of Diagnostic Radiology, and Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
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112
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Hawtin KE, Roddie ME, Mauri FA, Copley SJ. Pulmonary sarcoidosis: the 'Great Pretender'. Clin Radiol 2010; 65:642-50. [PMID: 20599067 DOI: 10.1016/j.crad.2010.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 03/03/2010] [Accepted: 03/10/2010] [Indexed: 01/15/2023]
Abstract
Sarcoidosis has a wide spectrum of appearances within the thorax. This review will discuss and illustrate the range of pulmonary manifestations on high-resolution computed tomography and chest radiography, concentrating on atypical features and examples of sarcoidosis mimicking other lung diseases. All included cases have been histologically confirmed. Such variable imaging appearances should alert the radiologist to consider sarcoidosis as a differential diagnosis in the context of interstitial lung disease.
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Affiliation(s)
- K E Hawtin
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
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113
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Hirschmann JV, Pipavath SNJ, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics 2010; 29:1921-38. [PMID: 19926754 DOI: 10.1148/rg.297095707] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most cases of hypersensitivity pneumonitis develop only after many years of inhaling allergens, which include microbes, animal or plant proteins, and certain chemicals that form haptens. The initial clinical presentation is either episodes of acute illness with dyspnea and prominent constitutional symptoms, such as fever, or an insidious onset of dyspnea, coughing, and weight loss, sometimes with superimposed acute episodes. The histopathologic process consists of chronic inflammation of the bronchi and peribronchiolar tissue, often with poorly defined granulomas and giant cells in the interstitium or alveoli. Fibrosis and emphysema may develop. The radiologic findings include diffuse ground-glass opacification, centrilobular ground-glass opacities, air trapping, fibrosis, lung cysts, and emphysema. The histologic and radiologic features in some cases may resemble those of usual interstitial pneumonia or nonspecific interstitial pneumonia. The diagnosis usually rests on a variable combination of findings from history, serology, radiography, lung biopsy, and bronchoalveolar lavage, which characteristically reveals a lymphocyte content of more than 30%, often with an increased CD4-to-CD8 ratio of T cells. Treatment includes avoiding the allergen, if possible, and, in severe cases, systemic corticosteroids. The long-term prognosis is usually good, but some patients develop severe respiratory insufficiency, and a few die of the disease.
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114
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Dinis MJ, Teles A, Carvalho I. Neumonitis por hipersensibilidad en el niño. Arch Bronconeumol 2010; 46:151-2. [DOI: 10.1016/j.arbres.2009.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/04/2009] [Accepted: 09/04/2009] [Indexed: 11/25/2022]
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115
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Abstract
The idiopathic interstitial pneumonias (IIPs) are a group of diffuse parenchymal lung diseases of unknown etiology characterized by the presence of various degrees of inflammation and fibrosis. Confident definitive diagnosis of the various IIPs requires dynamic interaction among clinicians, radiologists, and pathologists to arrive at a clinico-radiologic-pathologic diagnosis. The aims of this manuscript are to summarize the characteristic clinical and histologic manifestations, and to describe and illustrate the high-resolution computed tomography manifestations of the IIPs. The focus will be on idiopathic pulmonary fibrosis (idiopathic usual interstitial pneumonia), nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, and acute interstitial pneumonia. High-resolution computed tomography plays an important role in the initial diagnosis, the assessment of disease extent, the likelihood of response to treatment and prognosis, and the assessment of complications.
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116
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Abstract
Despite federally mandated safety standards, occupational lung disease remains one of the most common work-related injuries. Inhaled dust can result in a range of tissue injury in the lung and can lead to significant respiratory insufficiency causing death. Although silicosis and coal worker's pneumoconiosis are becoming less common, hypersensitivity pneumonitis is increasingly recognized as an occupational lung disease with new antigens being introduced annually. Imaging, particularly high-resolution computed tomography, is central to the management of occupational lung disease and is useful in diagnosis, assessment of disease activity, and evaluating response to therapy.
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117
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Lima MS, Coletta ENAM, Ferreira RG, Jasinowodolinski D, Arakaki JSO, Rodrigues SCS, Rocha NANS, Pereira CAC. Subacute and chronic hypersensitivity pneumonitis: histopathological patterns and survival. Respir Med 2010; 103:508-15. [PMID: 19179061 DOI: 10.1016/j.rmed.2008.12.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 12/09/2008] [Accepted: 12/22/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND In hypersensitivity pneumonitis (HP), survival can be predicted on the basis of the severity of fibrosis in surgical lung biopsy, but few data are available on the influence of clinical, functional, tomographic and histologic findings on prognosis. OBJECTIVES To describe the impact on survival of clinical data, histological patterns, and HRCT findings in subacute/chronic HP. METHODS A retrospective analysis of 103 patients diagnosed with HP submitted to surgical lung biopsy. Chronic HP was characterized by HRCT findings indicative of fibrosis (n=76). RESULTS The most relevant exposures were to molds and birds. Lung biopsies revealed typical HP with granulomas in 46 patients, bronchiolocentric interstitial pneumonia in 27, and non-specific interstitial pneumonia (NSIP) in 16. By univariate analysis, several findings were predictors of mortality: older age, male sex, velcro crackles, higher FEV(1)/FVC ratio, lower oxygen saturation during exercise, and absence of mosaic pattern/air trapping and presence of fibrosis on HRCT. By multivariate analysis, remained significant: age (p=0.007), oxygen saturation during exercise (p=0.003), and mosaic pattern/air trapping on HRCT (p=0.004). Patients with NSIP had a greater survival than did those with typical histology and those with bronchiolocentric pneumonia (p=0.033). CONCLUSIONS A wide range of histological features are found in HP. Typical findings are seen in 45% of cases. Other common patterns are NSIP and centriacinar lesions. Survival is better in patients with NSIP and worse in those with older age, desaturation during exercise, and absence of mosaic pattern/air trapping on HRCT.
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Affiliation(s)
- Mariana S Lima
- Division of Respiratory Diseases, Department of Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil.
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118
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Abstract
OBJECTIVE The purpose of this article is to describe the high-resolution CT (HRCT) features of uncommon occupational lung diseases. CONCLUSION HRCT plays an increasing role in the evaluation of occupational lung diseases. We present several cases of unusual occupational lung diseases and their HRCT findings. The diseases studied were siderosis, talcosis, berylliosis, calcicosis, hypersensitivity pneumonitis (due to wheat flour and isocyanates), and Ardystil syndrome. The characteristic HRCT findings together with clinical features and related occupational history improve the diagnostic accuracy of these diseases.
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119
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Pipavath SN, Godwin JD, Kanne JP. Occupational Lung Disease: A Radiologic Review. Semin Roentgenol 2010; 45:43-52. [DOI: 10.1053/j.ro.2009.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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120
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Wang P, Xu ZJ, Xu WB, Shi JH, Tian XL, Feng RE, Zhu YJ. Clinical Features and Prognosis in 21 Patients with Extrinsic Allergic Alveolitis. ACTA ACUST UNITED AC 2009; 24:202-7. [DOI: 10.1016/s1001-9294(10)60002-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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121
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122
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Abstract
Significant advances continue in the subjective and quantifiable imaging features of asthma. Radiologists need to be aware of not only the general features, but also potential asthma mimics as well as complications.
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Affiliation(s)
- Alyn Q Woods
- Division of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
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123
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Akashi T, Takemura T, Ando N, Eishi Y, Kitagawa M, Takizawa T, Koike M, Ohtani Y, Miyazaki Y, Inase N, Yoshizawa Y. Histopathologic analysis of sixteen autopsy cases of chronic hypersensitivity pneumonitis and comparison with idiopathic pulmonary fibrosis/usual interstitial pneumonia. Am J Clin Pathol 2009; 131:405-15. [PMID: 19228646 DOI: 10.1309/ajcpnwx4slzrp9sw] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of organic substances and certain inorganic chemicals. The histopathologic features of chronic HP (CHP) have not been studied extensively. We examined the pathologic characteristics of 16 autopsy cases of clinically confirmed CHP and compared them with 11 cases of idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP). To clarify the exact intralobular location of the fibrotic lesions, we conducted 3-dimensional reconstruction of fibrosis of CHP and IPF/UIP. Granuloma was not detected in any CHP case. Similar to IPF/UIP, honeycombing lesions were found dominantly in the lower lobes in most CHP cases; upper lobe dominance and asymmetrical distribution of honeycomb lesions were more frequent in CHP than in IPF/UIP. In all lungs affected by CHP, centrilobular fibrosis was outstanding, often connecting to the perilobular areas in the appearance of "bridging fibrosis," which was clearly demonstrated by 3-dimensional imaging. Centrilobular and bridging fibrosis were significantly more conspicuous in CHP than IPF/UIP; however, considerable overlap was found. It is important to thoroughly explore the possibility of antigen exposure in cases of lungs with UIP with centrilobular fibrosis to discriminate CHP from IPF/UIP.
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124
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Lee SS, Choo YK, Bang CS, Kim YS, Park JS, Jee YK, Kim DH, Myong NH. A Case of Hypersensitivity Pneumonitis Following Placenta Extract Injection. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.66.6.471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sang Seok Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Young Kwang Choo
- Division of Pulmonology and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Chang Seok Bang
- Division of Pulmonology and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Youn Seup Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jae Seuk Park
- Division of Pulmonology and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Young Koo Jee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Doh Hyung Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Na Hye Myong
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
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125
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Park MS. Diagnosis and Treatment of Hypersensitivity Pneumonitis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Moo Suk Park
- Department of Internal Medicine, Yonsei University College of Medicine, Korea.
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126
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Abstract
Chronic cough is a common symptom in a wide range of respiratory conditions, and may also occur as a result of upper airway or gastro-esophageal problems. Whilst chronic cough of any cause may be exacerbated by work, in some cases it has a direct occupational cause, resulting from a harmful acute or chronic workplace exposure. Such occupational conditions may only be suspected by taking a detailed occupational history, and directly asking employed patients whether their cough improves away from work. Early and accurate diagnosis, linked with tailored drug therapy, modification of workplace exposures, and expert compensation advice is likely to offer the best outcome for this group of patients.
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Affiliation(s)
- CM Barber
- Centre for Workplace Health, University of Sheffield; Royal Hallamshire Hospital, Sheffield, UK
| | - D Fishwick
- Centre for Workplace Health, University of Sheffield; Royal Hallamshire Hospital, Sheffield, UK
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127
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Tonelli AR, Lottenberg R, Allan RW, Sriram PS. Rituximab-induced hypersensitivity pneumonitis. ACTA ACUST UNITED AC 2008; 78:225-9. [PMID: 18843175 DOI: 10.1159/000163069] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 06/25/2008] [Indexed: 11/19/2022]
Abstract
Rituximab is a chimeric anti-CD20 monoclonal antibody used to treat CD20+ non-Hodgkin's lymphoma. Although pulmonary adverse reactions such as cough, rhinitis, bronchospasm, dyspnea and sinusitis are relatively common, other respiratory conditions like cryptogenic organizing pneumonia, interstitial pneumonitis and diffuse alveolar hemorrhage have rarely been reported. Only 2 possible cases of rituximab-associated hypersensitivity pneumonitis have been described to date. We present a case of hypersensitivity pneumonitis with classic radiographic and histopathologic findings in a patient treated with rituximab who responded to prednisone.
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Affiliation(s)
- Adriano R Tonelli
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA.
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128
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Abstract
PURPOSE OF REVIEW Hypersensitity pneumonitis, caused by inhalation of various antigens, is characterized by interstitial mononuclear cell infiltration, nonnecrotizing granulomas, cellular bronchiolitis, and fibrosis. The pathological picture of chronic hypersensitivity pneumonitis is, however, complicated; it is sometimes difficult to differentiate chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia, nonspecific interstitial pneumonia, and connective-tissue-related lung disease. The clinical, radiological, and pathological features of chronic hypersensitivity pneumonitis have recently been described. This study reviews the previously reported information and provides new insights into the pathological features of chronic hypersensitivity pneumonitis. RECENT FINDINGS The pathological features of chronic hypersensitivity pneumonitis comprise overlapping usual interstitial pneumonia-like pattern with subpleural patchy fibrosis, alternating normal alveoli and fibroblastic foci, a nonspecific interstitial pneumonia-like pattern, and centrilobular fibrosis. In contrast to pathological features of acute and subacute hypersensitivity pneumonitis, epithelioid cell granulomas are sparse or absent, but giant cells are seen in the interstitium. Bridging fibrosis between peribronchiolar area and perilobular areas is an outstanding feature of chronic hypersensitivity pneumonitis. Autopsy cases of chronic hypersensitivity pneumonitis have demonstrated not only upper lobe contraction but also lower lobe contraction, mimicking usual interstitial pneumonia pattern and diffuse alveolar damage. SUMMARY The present review focuses on the pathological features of chronic hypersensitivity pneumonitis and presents that centrilobular fibrosis and bridging fibrosis are the important hallmarks of chronic hypersensitivity pneumonitis, even with a usual interstitial pneumonia-like pattern.
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129
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Rosas IO, Richards TJ, Konishi K, Zhang Y, Gibson K, Lokshin AE, Lindell KO, Cisneros J, MacDonald SD, Pardo A, Sciurba F, Dauber J, Selman M, Gochuico BR, Kaminski N. MMP1 and MMP7 as potential peripheral blood biomarkers in idiopathic pulmonary fibrosis. PLoS Med 2008; 5:e93. [PMID: 18447576 PMCID: PMC2346504 DOI: 10.1371/journal.pmed.0050093] [Citation(s) in RCA: 410] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 03/13/2008] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic lung disease associated with substantial morbidity and mortality. The objective of this study was to determine whether there is a peripheral blood protein signature in IPF and whether components of this signature may serve as biomarkers for disease presence and progression. METHODS AND FINDINGS We analyzed the concentrations of 49 proteins in the plasma of 74 patients with IPF and in the plasma of 53 control individuals. We identified a combinatorial signature of five proteins-MMP7, MMP1, MMP8, IGFBP1, and TNFRSF1A-that was sufficient to distinguish patients from controls with a sensitivity of 98.6% (95% confidence interval [CI] 92.7%-100%) and specificity of 98.1% (95% CI 89.9%-100%). Increases in MMP1 and MMP7 were also observed in lung tissue and bronchoalveolar lavage fluid obtained from IPF patients. MMP7 and MMP1 plasma concentrations were not increased in patients with chronic obstructive pulmonary disease or sarcoidosis and distinguished IPF compared to subacute/chronic hypersensitivity pneumonitis, a disease that may mimic IPF, with a sensitivity of 96.3% (95% CI 81.0%-100%) and specificity of 87.2% (95% CI 72.6%-95.7%). We verified our results in an independent validation cohort composed of patients with IPF, familial pulmonary fibrosis, subclinical interstitial lung disease (ILD), as well as with control individuals. MMP7 and MMP1 concentrations were significantly higher in IPF patients compared to controls in this cohort. Furthermore, MMP7 concentrations were elevated in patients with subclinical ILD and negatively correlated with percent predicted forced vital capacity (FVC%) and percent predicted carbon monoxide diffusing capacity (DLCO%). CONCLUSIONS Our experiments provide the first evidence for a peripheral blood protein signature in IPF to our knowledge. The two main components of this signature, MMP7 and MMP1, are overexpressed in the lung microenvironment and distinguish IPF from other chronic lung diseases. Additionally, increased MMP7 concentration may be indicative of asymptomatic ILD and reflect disease progression.
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Affiliation(s)
- Ivan O Rosas
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Diseases, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Thomas J Richards
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Diseases, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Kazuhisa Konishi
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Diseases, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Yingze Zhang
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Diseases, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Kevin Gibson
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Diseases, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Anna E Lokshin
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Kathleen O Lindell
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Diseases, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Jose Cisneros
- Instituto Nacional de Enfermedades Respiratorias, México DF, México
| | - Sandra D MacDonald
- Pulmonary-Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Annie Pardo
- Facultad de Ciencias, Universidad Nacional Autónoma de México, México, Mexico
| | - Frank Sciurba
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Diseases, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - James Dauber
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Diseases, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias, México DF, México
- * To whom correspondence should be addressed. E-mail: (NK); (BRG); (MS)
| | - Bernadette R Gochuico
- Pulmonary-Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * To whom correspondence should be addressed. E-mail: (NK); (BRG); (MS)
| | - Naftali Kaminski
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Diseases, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- * To whom correspondence should be addressed. E-mail: (NK); (BRG); (MS)
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Hanak V, Golbin JM, Hartman TE, Ryu JH. High-resolution CT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis. Chest 2008; 134:133-8. [PMID: 18403660 DOI: 10.1378/chest.07-3005] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Histopathologic evidence of fibrosis on surgical lung biopsy has been associated with reduced survival in patients with hypersensitivity pneumonitis (HP). Changes of pulmonary fibrosis detected on CT may also correlate with prognosis in patients with HP. METHODS We identified 69 consecutive patients with HP diagnosed between January 1997 and December 2002 at Mayo Clinic, Rochester, MN. Patients were stratified into fibrotic and nonfibrotic groups based on the CT findings. Fibrosis was defined by the presence of irregular linear opacities, traction bronchiectasis, or honeycombing. MEASUREMENTS AND MAIN RESULTS Of 69 patients, 26 were classified as fibrotic and 43 as nonfibrotic. Patients in the fibrotic group were older, had longer symptom duration, were more likely to have crackles on auscultation, more likely to be exposed to avian antigen, and had greater restrictive lung impairment (p<0.05 for all comparisons). There were 11 deaths in the fibrotic group and 1 death in the nonfibrotic group (p<0.0001). In the regression analysis, CT evidence of fibrosis, more severe pulmonary function abnormalities, and the presence of crackles on auscultation were predictive of reduced survival (p<0.05 for all). The presence as well as the extent of fibrosis on CT was associated with increased mortality. The age-adjusted hazard ratio for mortality in patients with fibrosis was 4.6 (95% confidence interval, 2.0 to 20.1; p<0.0001). CONCLUSION CT findings of parenchymal fibrosis are associated with reduced survival in patients with HP and may serve as a useful prognostic indicator.
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Affiliation(s)
- Viktor Hanak
- Division of Pulmonary, Critical Care, and Sleep, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Mark EJ, Ruangchira-urai R. Bronchiolitis interstitial pneumonitis: a pathologic study of 31 lung biopsies with features intermediate between bronchiolitis obliterans organizing pneumonia and usual interstitial pneumonitis, with clinical correlation. Ann Diagn Pathol 2007; 12:171-80. [PMID: 18486892 DOI: 10.1016/j.anndiagpath.2007.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bronchiolitis combined with interstitial pneumonitis generally has been equated with bronchiolitis obliterans organizing pneumonia (BOOP). We describe our experience with lung biopsies that had both bronchiolar and interstitial diseases. We studied 31 patients who had respiratory difficulty leading to open lung biopsy, which showed a combination of both prominent bronchiolitis and prominent interstitial pneumonitis. We compared these cases clinically and pathologically with 6 other pulmonary diseases, namely, bronchiolitis obliterans, BOOP, nonspecific interstitial pneumonitis, usual interstitial pneumonitis, airway-centered interstitial fibrosis, and idiopathic bronchiolocentric interstitial pneumonia, and with 10 cases of cystic fibrosis, an unrelated disease with both bronchiolar and interstitial pathology. The commonality of our cases was a combination of bronchiolitis and interstitial inflammation and fibrosis but little or no intra-alveolar organizing pneumonia. Bronchiolitis obliterans with organizing pneumonia involved less area than the interstitial pneumonitis in each case. All 19 patients for whom we had follow-up received corticosteroids for their pulmonary diseases. Seven patients had improvement in symptoms and pulmonary function test results and radiographic findings, 5 patients experienced subjective improvement with unchanged results of pulmonary function tests or chest x-ray, 1 patient's condition was unchanged, 6 patients' disease worsened, and 4 of these 6 died. The natural history of these cases, which we have designated bronchiolitis interstitial pneumonitis, seems more sanguine than usual interstitial pneumonitis and worse than BOOP at least in the short term. On the one hand, response to corticosteroids was not as frequent as generally accepted for BOOP. On the other hand, disease did not progress in most patients on corticosteroids.
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Affiliation(s)
- Eugene J Mark
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02214, USA.
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