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Fu JT, Tan YS, Chung PC, Tsai YH, Fu PK, Chen CJ. Enhancing Organizing Pneumonia Diagnosis: A Novel Super-token Transformer Approach for Masson Body Segmentation. In Vivo 2024; 38:2239-2244. [PMID: 39187358 PMCID: PMC11363796 DOI: 10.21873/invivo.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/12/2024] [Accepted: 06/26/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND/AIM In this study, we introduce an innovative deep-learning model architecture aimed at enhancing the accuracy of detecting and classifying organizing pneumonia (OP), a condition characterized by the presence of Masson bodies within the alveolar spaces due to lung injury. The variable morphology of Masson bodies and their resemblance to adjacent pulmonary structures pose significant diagnostic challenges, necessitating a model capable of discerning subtle textural and structural differences. Our model incorporates a novel architecture that integrates advancements in three key areas: Semantic segmentation, texture analysis, and structural feature recognition. MATERIALS AND METHODS We employed a dataset of whole slide imaging from 20 patients, totaling 100 slides of OP, segmented into training, validation, and testing sets to reflect real-world application scenarios. Our approach utilizes a modified multi-head self-attention mechanism combined with ResUNet for semantic segmentation, enhanced by superpixel concepts. This method facilitates the generation of representative token features through iterative super-token blocks, creating high-resolution token maps that leverage local and high-level feature information for improved accuracy. RESULTS Benefiting from token features and distribution for enhanced texture alignment with fewer false-positives, the super-token transformer (STT) model achieved a mean intersection over union (mIOU) of 72.42%, with a sensitivity of 47.81%, specificity of 99.83%, positive predictive value of 64.03%, and negative predictive value of 99.94%, highlighting superior efficacy in Masson body segmentation in complex cross-tissue analyses. CONCLUSION Our team developed an iterative learning model based on the STT approach, emphasizing token features of super token, including texture and distribution, that enable enhanced alignment with the unique textures of Masson bodies to improve sensitivity and mIOU, The development of this STT model presents a significant advancement in the field of medical image analysis for OP that offers a promising avenue for improving diagnostic precision and patient outcomes in pulmonary pathology.
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Affiliation(s)
- Jing-Tong Fu
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Yi-Siang Tan
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C
| | - Pau-Choo Chung
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C
| | - Yu Hsin Tsai
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Pin-Kuei Fu
- Division of Clinical Research, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, R.O.C
| | - Chih Jung Chen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, R.O.C
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
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2
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Feng M, Zhang J, Li X, Wang S, Li Y, Dong C. Case report: Suspected organizing pneumonia secondary to severe respiratory syncytial virus pneumonia in an elderly patient. Front Med (Lausanne) 2024; 11:1394542. [PMID: 39040894 PMCID: PMC11260806 DOI: 10.3389/fmed.2024.1394542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024] Open
Abstract
Respiratory syncytial virus (RSV) usually causes acute respiratory tract infection in infants. In recent years, it has gradually become an important pathogen of lower respiratory tract infection in elderly people with an underlying disease. However, at present, the treatment of severe RSV pneumonia in adults is unclear, and organizing pneumonia (OP) after severe RSV infection has rarely been reported. We reported a 76-year-old man with multiple chronic heart and lung diseases who presented with fever, cough and progressive dyspnea. Finally, severe RSV pneumonia was diagnosed after his nasopharyngeal swabs and bronchoalveolar lavage metagenomic next-generation sequencing tests were positive for RSV. After combined treatment with oral ribavirin, intravenous immunoglobulin and corticosteroids, the patient's condition largely resolved, and he was discharged. However, when the corticosteroids were gradually tapered, the disease relapsed twice, and the patient experienced fever and aggravated dyspnea. Despite the lack of pathological evidence, we highly suspected organizing pneumonia secondary to severe RSV pneumonia based on the typical imaging manifestations and the clinical characteristics of a good response to corticosteroids. Finally, this patient was successfully treated with a course of corticosteroids and followed up for 14 months in total.
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Affiliation(s)
- Min Feng
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiangrui Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuai Wang
- School of Health Care Technology, Dalian Neusoft University of Information, Dalian, China
| | - Yanxia Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chang Dong
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
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3
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Yabuuchi Y, Minami Y, Kuroda A, Ooba N, Matsuda T, Kanazawa J, Miura Y, Usui S, O-Ishi S, Hayashihara K, Saito T, Hizawa N. Organizing Pneumonia in a Case of Cold Agglutinin Disease with Pulmonary Thrombosis. Intern Med 2024; 63:1801-1806. [PMID: 37952958 PMCID: PMC11239267 DOI: 10.2169/internalmedicine.2368-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023] Open
Abstract
Cold agglutinin disease is a subtype of autoimmune hemolytic anemia that occurs via the activation of specific anti-red blood cell antibodies (agglutinins) at low temperatures. Autoimmune hemolytic anemia has been reported to cause interstitial pneumonia; however, the underlying mechanism remains unclear. We herein report a 46-year-old man diagnosed with cold agglutinin disease complicated by pulmonary thrombosis and organizing pneumonia. Treatment with prednisolone improved the course of cold agglutinin disease and organizing pneumonia in a similar manner. To our knowledge, this is the first report of cold agglutinin associated with organizing pneumonia, suggesting a potential link between the two.
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Affiliation(s)
- Yuki Yabuuchi
- Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Japan
| | - Yuko Minami
- Department of Pathology, National Hospital Organization, Ibaraki Higashi National Hospital, Japan
| | - Akihiro Kuroda
- Hematology and Oncology Division, Hitachi General Hospital, Japan
| | - Norimasa Ooba
- Department of Urology, Mito Saiseikai General Hospital, Japan
| | - Takashi Matsuda
- Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Japan
| | - Jun Kanazawa
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Japan
| | - Yukiko Miura
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Japan
| | - Shingo Usui
- Clinical Research, National Hospital Organization, Ibaraki Higashi National Hospital, Japan
| | - Shuji O-Ishi
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Japan
| | - Kenji Hayashihara
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Japan
| | - Takefumi Saito
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Japan
| | - Nobuyuki Hizawa
- Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
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4
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Kligerman S. Imaging of the Spectrum of Acute Lung Injury. Clin Chest Med 2024; 45:357-371. [PMID: 38816093 DOI: 10.1016/j.ccm.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Organizing pneumonia, acute fibrinous and organizing pneumonia, and diffuse alveolar damage, represent multi-compartment patterns of lung injury. The initial region of injury in all remains the same and is centered on the fused basement membrane (BM) between the capillary endothelium and type I pneumocyte. Injury leads to cellular death, BM denudation, increased cellular permeability, and BM structural damage, which leads to exudation, organization, and attempts at repair. When acute lung injury does lead to fibrosis, in some instances it can lead to histologic and/or radiologic usual interstitial pneumonia or nonspecific interstital pneumonia patterns suggesting that lung injury is the primary mechanism for the development of fibrosis.
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Affiliation(s)
- Seth Kligerman
- Department of Radiology, National Jewish Health, 3131 East Alameda Avenue, Unit 1302, Denver, CO 80209, USA.
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5
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Yanoma S, Ugajin M, Kani H. A Case of Chronic Pulmonary Aspergillosis due to Pulmonary Infarction, Mimicking Cryptogenic Organising Pneumonia. Eur J Case Rep Intern Med 2024; 11:004501. [PMID: 38846666 PMCID: PMC11152216 DOI: 10.12890/2024_004501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 06/09/2024] Open
Abstract
A patient initially treated with corticosteroids for cryptogenic organising pneumonia following pulmonary infarction, developed a worsening condition with progressive cavitary formations in both lower lung lobes. Contrast-enhanced chest computed tomography revealed a pulmonary embolism, and serum anti-Aspergillus IgG antibody analysis yielded a strong positive result. Consequently, the patient was diagnosed with pulmonary infarction with Aspergillus infection; organising pneumonia in surrounding areas reflected the repair process. Following treatment with anticoagulants and antifungal agents, the patient was successfully discharged. Hence, pulmonary infarction should be considered in cases of refractory lung lesions. LEARNING POINTS Pulmonary infarction should be considered in case of refractory lung lesions, even if the patient does not have the risk of embolism.Organising pneumonia should be assessed carefully because it may occur as a repair process of various lung diseases.
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Affiliation(s)
- Saki Yanoma
- Department of Respiratory Medicine, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Motoi Ugajin
- Department of Respiratory Medicine, Nagoya Tokushukai General Hospital, Kasugai City, Japan
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute City, Japan
| | - Hisanori Kani
- Department of Thoracic Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
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6
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Sansen PY, Coche E, Hainaut P, Froidure A, Scohy A, Ghaye B, Belkhir L, De Greef J. Secondary organizing pneumonia associated with protracted COVID: A case series. Infect Dis Now 2024; 54:104888. [PMID: 38494118 DOI: 10.1016/j.idnow.2024.104888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Immunocompromised B-cell-depleted patients are at risk of developing protracted COVID-19, a clinical syndrome characterized by prolonged viral shedding and respiratory symptoms that can lead to hypoxemic pneumonia. Our aim is to describe this unusual condition and its treatment. PATIENTS AND METHODS This monocentric retrospective study reports six cases of severe organizing pneumonia that developed during the clinical course of protracted COVID-19. RESULTS All patients developed organizing pneumonia (OP) in the setting of protracted COVID. Clinical improvement was obtained after several treatment lines including specific antiviral agents and occurred simultaneously with control of the viral load. CONCLUSION As it was the most frequent presentation of protracted COVID-19 in our survey, we believe that this specific form of organizing pneumonia warrants increased awareness. Furthermore, specific antiviral therapy seems to control this condition.
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Affiliation(s)
- P-Y Sansen
- Service de Médecine interne et Maladies Infectieuses, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.
| | - E Coche
- Service de Radiologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - P Hainaut
- Service de Médecine interne et Maladies Infectieuses, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - A Froidure
- Service de Pneumologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - A Scohy
- Service de Microbiologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - B Ghaye
- Service de Radiologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - L Belkhir
- Service de Médecine interne et Maladies Infectieuses, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - J De Greef
- Service de Médecine interne et Maladies Infectieuses, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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7
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Yomota M, Tanaka M, Kobayashi T, Kitano M, Ikeda S, Kanemasa Y, Yanagawa N, Hosomi Y. Interstitial lung changes and persistent COVID-19 in a patient with follicular lymphoma: A case report. Respirol Case Rep 2024; 12:e01298. [PMID: 38379821 PMCID: PMC10878828 DOI: 10.1002/rcr2.1298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
We herein report a case of interstitial lung changes in a patient with prolonged coronavirus disease 2019 (COVID-19) with follicular lymphoma receiving rituximab and bendamustine who recovered after treatment with a combination therapy consisting of corticosteroids and immunosuppressive agents. There is currently no treatment strategy for prolonged pneumonitis following COVID-19, which can be life-threatening for immunocompromised patients. Thus, further investigation is warranted.
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Affiliation(s)
- Makiko Yomota
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Masaru Tanaka
- Department of Infectious DiseasesTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Takayuki Kobayashi
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Masatake Kitano
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Saori Ikeda
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Yusuke Kanemasa
- Department of OncologyTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Noriyo Yanagawa
- Department of RadiologyTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Yukio Hosomi
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
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8
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Reddy BSK, Ghewade B, Jadhav U, Wagh P. Scleroderma Associated With Organising Pneumonia and Polyarthritis: A Report of a Rare Case. Cureus 2024; 16:e52886. [PMID: 38406027 PMCID: PMC10891365 DOI: 10.7759/cureus.52886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Cryptogenic organising pneumonia (COP) is a form of idiopathic diffuse interstitial lung disease (ILD) that develops in response to a variety of unknown irritants. An essential component of the development of organising pneumonia (OP) is damage to type II pneumocytes and the alveolar basement membrane. An autoimmune illness called systemic sclerosis (SSc) has a significant death rate from cardiopulmonary involvement such as pulmonary hypertension and ILD. Arthritis is an autoimmune disorder, in which the patients experience extra-articular symptoms such as ILD during the course of their disease, and COP frequently coexists with these conditions. It is exceedingly uncommon for OP to occur as the initial sign of arthritis, and its clinical characteristics are still unclear. Scleroderma and inflammatory polyarthritis related to COP are presented in this report.
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Affiliation(s)
- Bingu Shiv Kiran Reddy
- Pulmonary and Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Babaji Ghewade
- Pulmonary and Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ulhas Jadhav
- Pulmonary and Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Wagh
- Pulmonary and Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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9
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Tonon CR, Tanni SE, Rocha J, Godoy I, Polegato BF, Pereira FWL, Martins D, Prudente RA, Franco ET, Brizola F, Baldi BG, Okoshi MP. Organizing pneumonia and COVID-19. Am J Med Sci 2023; 366:458-463. [PMID: 37778722 DOI: 10.1016/j.amjms.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
Organizing pneumonia (OP) is an interstitial lung disease, and can be cryptogenic, if no cause is identified, or secondary to several conditions. COVID-19-induced persistent inflammation can be associated with interstitial lung disease. We present a review of literature of OP and COVID-19-induced OP with an illustrative case. A 38-year-old man was admitted with COVID-19 that required mechanical ventilation for 56 days. Initial chest computed tomography (CT) revealed diffuse bilateral ground-glass opacities in the lungs with consolidation areas involving 75 % of the parenchyma. After weaning from MV, the patient still required oxygen supplementation. A new chest CT scan also showed extensive diffuse areas of consolidation and ground-glass opacity. OP was hypothesized and 40 mg/day prednisone initiated and continued for six months with resolution of lung functional and image abnormalities. Organizing pneumonia should be included in the differential diagnosis of COVID-19 patients with respiratory symptoms after partial pulmonary recovery.
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Affiliation(s)
- Carolina Rodrigues Tonon
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Suzana Erico Tanni
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Juliana Rocha
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Irma Godoy
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Bertha Furlan Polegato
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Filipe Welson Leal Pereira
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Danilo Martins
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Robson Aparecido Prudente
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Estefania Thome Franco
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Fernando Brizola
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Bruno Guedes Baldi
- Pneumology Division, Heart Institute (InCor), Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marina Politi Okoshi
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil.
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10
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Leung CCD, Yeung YC. A case series of three patients with histologically proven post COVID-19 organizing pneumonia. Respirol Case Rep 2023; 11:e01229. [PMID: 37771848 PMCID: PMC10523094 DOI: 10.1002/rcr2.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
Organizing pneumonia, a form of interstitial lung disease, may occur in patients who have recovered from COVID-19. In this article, we report three cases of post COVID-19 organizing pneumonia, proven histologically with transbronchial biopsies showing fibroblastic plugs in the alveolar spaces. Our patients received a range of 86-166 days of continuous corticosteroid therapy and all of them made excellent recovery.
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Affiliation(s)
| | - Yiu Cheong Yeung
- Department of Medicine and GeriatricsPrincess Margaret HospitalKowloonHong Kong
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11
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Youn JY, Middlekauff HR, Reudiseuli I, Huang K, Cai H. Endothelial damage in young adult e-cigarette users. Redox Biol 2023; 62:102688. [PMID: 37018969 PMCID: PMC10121999 DOI: 10.1016/j.redox.2023.102688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Ji Youn Youn
- Department of Anesthesiology, Department of Medicine, University of California Los Angeles, USA
| | | | | | - Kai Huang
- Department of Anesthesiology, Department of Medicine, University of California Los Angeles, USA
| | - Hua Cai
- Department of Anesthesiology, Department of Medicine, University of California Los Angeles, USA; Department of Medicine, University of California Los Angeles, USA.
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12
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Tiew HW, Tan JWP, Teo CHY. Delayed organising pneumonia in an immunocompromised host after a mild COVID-19 infection. BMJ Case Rep 2023; 16:16/5/e254737. [PMID: 37192779 DOI: 10.1136/bcr-2023-254737] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Organising pneumonia after a mild COVID-19 infection has been increasingly reported and poses a diagnostic challenge to physicians especially in immunocompromised patients. We report a patient with a background of lymphoma in remission on rituximab who presented with prolonged and persistent fever after recovering from a mild COVID-19 infection. The initial workup showed bilateral lower zone lung consolidation; however, the infective and autoimmune workup were unremarkable. Subsequently, a bronchoscopy with transbronchial lung biopsy confirmed the diagnosis of organising pneumonia. A tapering glucocorticoid regimen was commenced with prompt resolution of the patient's clinical symptoms, and subsequent resolution of biochemical markers and radiological lung changes 3 months later. This case highlights the importance of early recognition of the diagnosis of organising pneumonia in immunocompromised populations after a mild COVID-19 infection as it shows promising response to glucocorticoid therapy.
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Affiliation(s)
- Han Wei Tiew
- General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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13
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Bae M, Song JS, Kim JY, Bae S, Jung J, Kim MJ, Chong YP, Lee SO, Choi SH, Kim YS, Kim SH. The relationship between organising pneumonia and invasive mould disease in patients with haematologic malignancy. Mycoses 2023; 66:289-298. [PMID: 36482152 DOI: 10.1111/myc.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Organising pneumonia (OP) is reported in patients with haematologic malignancy suspected of having invasive mould disease, yet little is known about this relationship. OBJECTIVE To investigate molecular evidence of invasive mould pneumonia in paraffin-embedded lung tissues from histologically diagnosed OP patients with suspected invasive mould pneumonia. PATIENTS/METHODS Patients with haematologic malignancy suspected to have invasive pulmonary mould disease who underwent lung biopsy at a tertiary hospital, Seoul, South Korea, between 2008 and 2020, were retrospectively reviewed. To find molecular evidence of fungal infection, PCR assay was used to detect Aspergillus- and Mucorales-specific DNA within OP lung tissue sections. RESULTS Forty-seven patients with suspected invasive mould pneumonia underwent lung biopsy and 15 (32%) were histologically diagnosed as OP without any evidence of fungal hyphae. Of these 15 patients, 3 (20%) received allogenic haematopoietic stem cell transplantation prior to developing OP. Before biopsy, 2 and 13 patients had probably and possible invasive mould disease, respectively. The median antifungal treatment length was 81 [8-114] days, and the median steroid treatment dosage was 0.35 mg/kg/day for 36 days (methylprednisolone equivalent doses), respectively. After biopsy, three patients with possible invasive mould infection revealed probable invasive pulmonary aspergillosis. From the 15 paraffin-embedded lung tissues, 6 (40%) exhibited positive PCR assay results for detecting Aspergillus- and Mucorales-specific DNA. CONCLUSIONS More than one third of OP cases in patients with suspected invasive mould pneumonia exhibited molecular evidence of invasive mould infection by fungus-specific PCR in lung tissues, likely associated with concurrent or prior fungal infection.
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Affiliation(s)
- Moonsuk Bae
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.,Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Yeun Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seongman Bae
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Jung
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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14
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AYSAN N, KÖYBAŞI G, SATICI C, DEMİRKOL M, YİĞİTBAŞ BA, KOŞAR A. Organizing pneumonia following ocrelizumab use in a patient with multiple sclerosis: A case report. Tuberk Toraks 2023; 71:107-111. [PMID: 36912415 PMCID: PMC10795250 DOI: 10.5578/tt.20239913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/14/2022] [Indexed: 03/14/2023] Open
Abstract
Ocrelizumab is an anti-CD20 monoclonal antibody used in the treatment of primary progressive and relapsing multiple sclerosis (MS). Although cases of organizing pneumonia have been reported in association with other antiCD20 agents such as rituximab, there is insufficient data in the literature on Ocrelizumab-associated lung involvement. Herein, we present a case of organizing pneumonia in a 37-year-old female patient with multiple sclerosis following Ocrelizumab use.
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Affiliation(s)
- N. AYSAN
- Clinic of Chest Diseases, İstanbul Yedikule Chest Diseases and Thoracic
Surgery Training and Research Hospital, İstanbul, Türkiye
- Clinic of Chest Diseases, Başakşehir Çam and Sakura City Hospital,
İstanbul, Türkiye
- Department of Chest Diseases, İstanbul Medeniyet University
Faculty of Medicine, İstanbul, Türkiye
| | - G. KÖYBAŞI
- Clinic of Chest Diseases, İstanbul Yedikule Chest Diseases and Thoracic
Surgery Training and Research Hospital, İstanbul, Türkiye
| | - C. SATICI
- Clinic of Chest Diseases, İstanbul Yedikule Chest Diseases and Thoracic
Surgery Training and Research Hospital, İstanbul, Türkiye
| | - M.A. DEMİRKOL
- Clinic of Chest Diseases, Başakşehir Çam and Sakura City Hospital,
İstanbul, Türkiye
| | - B. A. YİĞİTBAŞ
- Department of Chest Diseases, İstanbul Medeniyet University
Faculty of Medicine, İstanbul, Türkiye
| | - A.F.A. KOŞAR
- Clinic of Chest Diseases, İstanbul Yedikule Chest Diseases and Thoracic
Surgery Training and Research Hospital, İstanbul, Türkiye
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15
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Remmington C, Barrett NA, Agarwal S, Lams B, Collins P, Camarda V, Meadows C, Hanks F, Sanderson B, Retter A, Camporota L. Steroid exposure and outcome in COVID-19 pneumonia. BJA OPEN 2023; 5:100128. [PMID: 36744291 PMCID: PMC9886648 DOI: 10.1016/j.bjao.2023.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
Background Corticosteroids are used to treat COVID-19 pneumonia. However, the optimal dose is unclear. This study describes the association between corticosteroid exposure with disease severity and outcome in COVID-19 pneumonia. Methods This is a single-centre retrospective, observational study including adult ICU patients who received systemic corticosteroids for COVID-19 pneumonia between March 2020 and March 2021. We recorded patient characteristics, disease severity, total steroid exposure, respiratory support and gas exchange data, and 90-day mortality. Results We included 362 patients. We allocated patients to groups with increasing disease severity according to the highest level of respiratory support that they received: high-flow nasal oxygen or continuous positive airway pressure (HFNO/CPAP) in 12.7%, invasive mechanical ventilation (IMV) in 61.6%, and extracorporeal membrane oxygenation (ECMO) in 25.7%. For these three groups, the median (inter-quartile range [IQR]) age was 61 (54-71) vs 58 (50-66) vs 46 (38-53) yr, respectively (P<0.001); median (IQR) APACHE (Acute Physiology and Chronic Health Evaluation) II scores were 12 (9-15) vs 14 (12-18) vs 15 (12-17), respectively (P=0.006); the median (IQR) lowest P a O 2 /FiO2 ratio was 15.1 (11.8-21.7) vs 15.1 (10.7-22.2) vs 9.5 (7.9-10.9) kPa, respectively (P<0.001). Ninety-day mortality was 9% vs 27% vs 37% (P=0.002). Median (IQR) dexamethasone-equivalent exposure was 37 (24-62) vs 174 (86-504) vs 535 (257-1213) mg (P<0.001). 'Pulsed' steroids were administered to 26% of the IMV group and 48% of the ECMO group. Patients with higher disease severity who received pulse steroids had a higher 90-day mortality. Conclusions Corticosteroid exposure increased with the severity of COVID-19 pneumonia. Pulsed dose steroids were used more frequently in patients receiving greater respiratory support. Future studies should address patient selection and outcomes associated with pulsed dose steroids in patients with severe and deteriorating COVID-19 pneumonia.
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Affiliation(s)
- Christopher Remmington
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Institute of Pharmaceutical Science, King's College London, London, UK,Corresponding author. Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas A Barrett
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK,Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Sangita Agarwal
- Department of Rheumatology and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Boris Lams
- Department of Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Patrick Collins
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Valentina Camarda
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Chris Meadows
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fraser Hanks
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Barnaby Sanderson
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Retter
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK,Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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16
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Ketchersid K. A review of organizing pneumonia. JAAPA 2023; 36:16-19. [PMID: 36749158 DOI: 10.1097/01.jaa.0000918776.59717.eb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
ABSTRACT Organizing pneumonia is a clinical and pathological syndrome that describes a lung injury caused by an inflammatory reaction in the alveolar connective tissue. Classified as an interstitial lung disease, it can be secondary to infection, drug toxicity, connective tissue disorders, inhalation injuries (cocaine), organ transplant, or radiotherapy, and also can be idiopathic. Although organizing pneumonia is not a new phenomenon, it has been noted to be a complication of COVID-19, and should be considered in patients who have had COVID-19 and have atypical chest imaging, because treatment includes corticosteroids instead of antimicrobials.
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Affiliation(s)
- Kimberlee Ketchersid
- Kimberlee Ketchersid practices in hospital medicine at VCU Health System in Richmond, Va., and is the manager of the APP Transition to Practice Program. The author has disclosed no potential conflicts of interest, financial or otherwise
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17
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Yamauchi M, Kanie N, Takahashi K, Katoh S. Case of organising pneumonia in HIV infection. BMJ Case Rep 2022; 15:e250544. [PMID: 36423937 PMCID: PMC9693662 DOI: 10.1136/bcr-2022-250544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A man in his 50s presented to his doctor with a fever, sore throat, cough, dysgeusia and dyspnoea of several days' duration. Tests for HIV antigen, HIV antibody and HIV PCR were positive. He was referred to our hospital for initiation of antiretroviral therapy and bronchoscopy to clarify the cause of an abnormal lung shadow on chest CT. He was diagnosed with organising pneumonia, with concurrent HIV infection. His pulmonary lesions were remitted spontaneously, and he was administered a fixed-dose combination of tenofovir (50 mg), emtricitabine (200 mg) and bictegravir (25 mg) for HIV. This is a rare report of organising pneumonia with HIV infection. Physicians need to consider organising pneumonia when lung opacity is observed in a patient with HIV infection.
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Affiliation(s)
- Momoko Yamauchi
- Department of Clinical medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Nobuhiro Kanie
- Department of Clinical medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kensuke Takahashi
- Department of Clinical medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Shungo Katoh
- General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan
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18
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Pathogenesis, Imaging, and Evolution of Acute Lung Injury. Radiol Clin North Am 2022; 60:925-939. [DOI: 10.1016/j.rcl.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Cherian SV, Patel D, Machnicki S, Naidich D, Stover D, Travis WD, Brown KK, Naidich JJ, Mahajan A, Esposito M, Mina B, Lakticova V, Cohen SL, Muller NL, Schulner J, Shah R, Raoof S. Algorithmic Approach to the Diagnosis of Organizing Pneumonia: A Correlation of Clinical, Radiologic, and Pathologic Features. Chest 2022; 162:156-178. [PMID: 35038455 PMCID: PMC9899643 DOI: 10.1016/j.chest.2021.12.659] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/23/2021] [Accepted: 12/27/2021] [Indexed: 01/19/2023] Open
Abstract
Organizing pneumonia (OP), characterized histopathologically by patchy filling of alveoli and bronchioles by loose plugs of connective tissue, may be seen in a variety of conditions. These include but are not limited to after an infection, drug reactions, radiation therapy, and collagen vascular diseases. When a specific cause is responsible for this entity, it is referred to as "secondary OP." When an extensive search fails to reveal a cause, it is referred to as "cryptogenic OP" (previously called "bronchiolitis obliterans with OP"), which is a clinical, radiologic, and pathologic entity classified as an interstitial lung disease. The clinical presentation of OP often mimics that of other disorders, such as infection and cancer, which can result in a delay in diagnosis and inappropriate management of the underlying disease. The radiographic presentation of OP is polymorphous but often has subpleural consolidations with air bronchograms or solitary or multiple nodules, which can wax and wane. Diagnosis of OP sometimes requires histopathologic confirmation and exclusion of other possible causes. Treatment usually requires a prolonged steroid course, and disease relapse is common. The aim of this article is to summarize the clinical, radiographic, and histologic presentations of this disease and to provide a practical diagnostic algorithmic approach incorporating clinical history and characteristic imaging patterns.
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Affiliation(s)
- Sujith V. Cherian
- Divisions of Critical Care, Pulmonary and Sleep Medicine, Dept. Of Internal Medicine, University of Texas Health-McGovern Medical School, Houston, TX
| | - Dhara Patel
- Pulmonary Medicine, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - Stephen Machnicki
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - David Naidich
- Department of Radiology, Center for Biologic Imaging, NYU-Langone Medical Center, New York, NY
| | - Diane Stover
- Pulmonary, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - William D. Travis
- Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Kevin K. Brown
- Department of Medicine, National Jewish Health, Denver, CO
| | - Jason J. Naidich
- Departments of Radiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,Pathology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,Northwell Health Lung Institute, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Akhilesh Mahajan
- Division of Pulmonary and Critical Care Medicine, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - Michael Esposito
- Pathology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Bushra Mina
- Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - Viera Lakticova
- Division of Pulmonary and Critical Care Medicine, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - Stuart L. Cohen
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Nestor L. Muller
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jenna Schulner
- Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY
| | - Rakesh Shah
- Departments of Radiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Suhail Raoof
- Northwell Health Lung Institute, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
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20
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Amratia DA, Viola H, Ioachimescu OC. Glucocorticoid therapy in respiratory illness: bench to bedside. J Investig Med 2022; 70:1662-1680. [DOI: 10.1136/jim-2021-002161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/07/2022]
Abstract
Each year, hundreds of millions of individuals are affected by respiratory disease leading to approximately 4 million deaths. Most respiratory pathologies involve substantially dysregulated immune processes that either fail to resolve the underlying process or actively exacerbate the disease. Therefore, clinicians have long considered immune-modulating corticosteroids (CSs), particularly glucocorticoids (GCs), as a critical tool for management of a wide spectrum of respiratory conditions. However, the complex interplay between effectiveness, risks and side effects can lead to different results, depending on the disease in consideration. In this comprehensive review, we present a summary of the bench and the bedside evidence regarding GC treatment in a spectrum of respiratory illnesses. We first describe here the experimental evidence of GC effects in the distal airways and/or parenchyma, both in vitro and in disease-specific animal studies, then we evaluate the recent clinical evidence regarding GC treatment in over 20 respiratory pathologies. Overall, CS remain a critical tool in the management of respiratory illness, but their benefits are dependent on the underlying pathology and should be weighed against patient-specific risks.
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21
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Anandan L, Carasco C, Mori L, Margaritopoulos GA. What you need to know about: organising pneumonia. Br J Hosp Med (Lond) 2022; 83:1-8. [PMID: 35787169 DOI: 10.12968/hmed.2021.0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Organising pneumonia was first described in the context of respiratory infection, but over time has become established as its own entity. It is an area of diagnostic complexity because of the non-specific presenting symptoms and signs that can often mimic other respiratory pathology. Multidisciplinary review to correlate clinical, radiological and histopathological features can aid timely and effective diagnosis. This article discusses the epidemiology, aetiology, clinical, radiological and histopathological features, investigation and management of organising pneumonia.
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Affiliation(s)
- Lavanya Anandan
- Interstitial Lung Disease Unit, London North West University Hospital Healthcare Trust, London, UK
| | - Clare Carasco
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Letizia Mori
- Interstitial Lung Disease Unit, London North West University Hospital Healthcare Trust, London, UK
| | - Georgios A Margaritopoulos
- Interstitial Lung Disease Unit, London North West University Hospital Healthcare Trust, London, UK.,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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22
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Todd NW, Atamas SP, Hines SE, Luzina IG, Shah NG, Britt EJ, Ghio AJ, Galvin JR. Demystifying idiopathic interstitial pneumonia: time for more etiology-focused nomenclature in interstitial lung disease. Expert Rev Respir Med 2022; 16:235-245. [PMID: 35034567 PMCID: PMC8983480 DOI: 10.1080/17476348.2022.2030710] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION A major focus of interstitial lung disease (ILD) has centered on disorders termed idiopathic interstitial pneumonias (IIPs) which include, among others, idiopathic pulmonary fibrosis, idiopathic nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, and respiratory bronchiolitis-interstitial lung disease. AREAS COVERED We review the radiologic and histologic patterns for the nine disorders classified by multidisciplinary approach as IIP, and describe the remarkable amount of published epidemiologic, translational, and molecular studies demonstrating their associations with numerous yet definitive environmental exposures, occupational exposures, pulmonary diseases, systemic diseases, medication toxicities, and genetic variants. EXPERT OPINION In the 21st century, these disorders termed IIPs are rarely idiopathic, but rather are well-described radiologic and histologic patterns of lung injury that are associated with a wide array of diverse etiologies. Accordingly, the idiopathic nomenclature is misleading and confusing, and may also promote a lack of inquisitiveness, suggesting the end rather than the beginning of a thorough diagnostic process to identify ILD etiology and initiate patient-centered management. A shift toward more etiology-focused nomenclature will be beneficial to all, including patients hoping for better life quality and disease outcome, general medicine and pulmonary physicians furthering their ILD knowledge, and expert ILD clinicians and researchers who are advancing the ILD field.
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Affiliation(s)
- Nevins W. Todd
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Sergei P. Atamas
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Stella E. Hines
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Irina G. Luzina
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Nirav G. Shah
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Edward J. Britt
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew J. Ghio
- Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Jeffrey R. Galvin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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23
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Zeng H, Ma Y, He X, Cai S, Chen P, Chen Y, Luo H. Characteristics and Follow-Up of Organizing Pneumonia Associated with Haematological Malignancies. Int J Gen Med 2022; 15:301-310. [PMID: 35027840 PMCID: PMC8752074 DOI: 10.2147/ijgm.s337321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Organizing pneumonia (OP) is a secondary process in many diseases. Due to its low incidence and indistinct symptoms, there is limited information on OP associated with haematological malignancies. Therefore, the aim of this study was to discuss the characteristics and prognosis of OP associated with haematological malignancies. Methods We observed and analysed pathologically confirmed OP cases associated with haematological malignancies in a hospital record database and excluded cases of OP with known causes, including chemotherapy, radiotherapy, targeted therapy, transplantation and infection. Results There were five patients with OP underlying only haematological malignancies, including one case each of the following: myelodysplastic syndrome, acute myelogenous leukaemia, multiple myeloma, aplastic anaemia, and T cell lymphoma. Radiological findings did not show a distinct pattern, and two cases mimicked pulmonary aspergillosis with ground-glass opacity (GGO). The diagnosis of OP was confirmed by minimal invasive biopsy. Although all patients developed severe cases, steroids yielded favourable outcomes. Conclusion This study demonstrates that haematological malignancies may be a cause of OP and that minimal invasive biopsy may be an effective and safe method to confirm the diagnosis. Although OP associated with haematological malignancies may more frequently develop into severe cases, the OP lesions were steroid-responsive during follow-up.
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Affiliation(s)
- Huihui Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Xue He
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Shan Cai
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
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24
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Pulmonary Toxicities of Immunotherapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1342:357-375. [PMID: 34972974 DOI: 10.1007/978-3-030-79308-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Immune checkpoint inhibitors are a form of immunotherapy that are increasingly being used in a wide variety of cancers. Immune-related adverse events (irAEs) pose a major challenge in the treatment of cancer patients. Pneumonitis, the most common lung irAE, can cause significant disruptions in the treatment of cancer and may be life-threatening. The goal of this chapter is to instruct readers on the incidence and clinical manifestations of pneumonitis and to offer guidance in the evaluation and treatment of patients with pneumonitis.
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25
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Abdul Hamid MF, Selvarajah SB, Nuratiqah N, Hau NB, Ban AY. Two cases of cryptogenic organizing pneumonia masquerading as tuberculosis (TB) in a TB endemic area. Respirol Case Rep 2022; 10:e0883. [PMID: 34876988 PMCID: PMC8629744 DOI: 10.1002/rcr2.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/03/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022] Open
Abstract
Before the era of COVID-19 pandemic, organizing pneumonia (OP) is often underdiagnosed while tuberculosis (TB) is overdiagnosed especially in an endemic area. We report two patients with cryptogenic OP mimicking TB. First, a 56-year-old lady with right upper lobe air space opacity and, second, a 37-year-old lady with left upper lobe cavitary lesion. They were treated empirically for pulmonary TB as they had chronic cough with typical chest imaging findings. As there were no improvements despite anti-TB and investigations for TB were negative, they underwent image-guided biopsy which confirmed OP. Both patients received 6 months of corticosteroids therapy and made complete recovery. These cases highlight the rare presentation of OP and serves as a reminder that patients tested negative for TB, despite typical history and chest imaging findings, warrant further investigations as many diseases may mimic TB and vice versa.
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Affiliation(s)
| | - Sai Banu Selvarajah
- Respiratory UnitUniversity Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Nik Nuratiqah
- Respiratory UnitUniversity Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Ng Boon Hau
- Respiratory UnitUniversity Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Andrea Yu‐Lin Ban
- Respiratory UnitUniversity Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
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26
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Lang JA, Bhalla S, Ganeshan D, Felder GJ, Itani M. Side Effects of Oncologic Treatment in the Chest: Manifestations at FDG PET/CT. Radiographics 2021; 41:2071-2089. [PMID: 34723703 DOI: 10.1148/rg.2021210130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fluorodeoxyglucose (FDG) PET/CT is a vital imaging technique used for staging, assessing treatment response, and restaging following completion of therapy in patients who are undergoing or have completed oncologic treatment. A variety of adverse effects from chemotherapy, targeted therapy, immunotherapy, and radiation therapy are commonly encountered in oncologic patients. It is important to be aware of the manifestations of these adverse effects seen on FDG PET/CT images to avoid misinterpreting these findings as disease progression. Furthermore, early identification of these complications is important, as it may significantly affect patient management and even lead to a change in treatment strategy. The authors focus on the FDG PET/CT manifestations of a broad spectrum of oncologic therapy-related adverse effects in the thorax, as well as some treatment-related changes that may potentially mimic malignancy. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Jordan A Lang
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Dhakshinamoorthy Ganeshan
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Gabriel J Felder
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
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Guarnera A, Santini E, Podda P. Idiopathic Interstitial Pneumonias and COVID-19 Pneumonia: Review of the Main Radiological Features and Differential Diagnosis. Tomography 2021; 7:397-411. [PMID: 34564297 PMCID: PMC8482091 DOI: 10.3390/tomography7030035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/28/2021] [Accepted: 08/16/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 pneumonia represents a challenging health emergency, due to the disproportion between the high transmissibility, morbidity, and mortality of the virus and healthcare systems possibilities. Literature has mainly focused on COVID-19 pneumonia clinical-radiological diagnosis and therapy, and on the most common differential diagnoses, while few papers investigated rare COVID-19 pneumonia differential diagnoses or the overlapping of COVID-19 pneumonia on pre-existing lung pathologies. This article presents the main radiological characteristics of COVID-19 pneumonia and Idiopathic Interstitial Pneumonias (IIPs) to identify key radiological features for a differential diagnosis among IIPs, and between IIPs and COVID-19 pneumonia. COVID-19 pneumonia differential diagnosis with IIPs is challenging, since these entities may share common radiological findings as ground glass opacities, crazy paving patterns, and consolidations. Multidisciplinary discussion is crucial to reach a final and correct diagnosis. Radiologists have a pivotal role in identifying COVID-19 pneumonia patterns, reporting possible overlapping with long-lasting lung diseases, and suggesting potential differential diagnoses. An optimal evaluation of HRTC may help in containing the disease, in promoting better treatment for patients, and in providing an efficient allocation of human and economic resources.
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Affiliation(s)
- Alessia Guarnera
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy
- Correspondence:
| | - Elena Santini
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
| | - Pierfrancesco Podda
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
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Grigoravičius D, Žurauskas E, Gruslys V, Zablockis R, Danila E. Case of Severe Treatment-Resistant Cryptogenic Organizing Pneumonia. Acta Med Litu 2021; 28:349-354. [PMID: 35474923 PMCID: PMC8958647 DOI: 10.15388/amed.2021.28.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/27/2021] [Accepted: 07/21/2021] [Indexed: 12/02/2022] Open
Abstract
Cryptogenic organizing pneumonia is a rare interstitial lung disease with different onset of symptoms, which responds rapidly to glucocorticoid treatment. We present a case of cryptogenic organizing pneumonia which manifested as a progressive 3-year dyspnea that ultimately has led to acute respiratory failure. Moreover, treatment with prednisone for this patient exhibited slow onset of the effect.
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29
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Segala FV, Sgalla G, Salvati F, Berardini L, Negri M, Nardella E, Potenza A, Murri R, Fantoni M. Adjunctive corticosteroid treatment for organizing pneumonia in COVID-19 patients with persistent respiratory failure. Respir Med 2021; 187:106571. [PMID: 34388415 PMCID: PMC8352674 DOI: 10.1016/j.rmed.2021.106571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/06/2021] [Indexed: 12/28/2022]
Abstract
Since the beginning of COVID-19 pandemic, clinical, radiological and histopathological features consistent with viral-induced organizing pneumonia (OP) have been reported as hallmark characteristics of the disease. Here, we describe the case of ten patients with severe COVID-19 pneumonia treated with methylprednisolone 1mg/kg for showing clinical and radiological features suggestive of OP at least 20 days after symptom onset and despite standard treatment for COVID-19.
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Affiliation(s)
| | - Giacomo Sgalla
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Federica Salvati
- Infectious Diseases Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Ludovica Berardini
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Marcantonio Negri
- Istituto di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisabetta Nardella
- Istituto di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annalisa Potenza
- Istituto di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rita Murri
- Division of Infectious Diseases, Department of Laboratory Sciences and Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Fantoni
- Division of Infectious Diseases, Department of Laboratory Sciences and Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Vancomycin-Induced Organizing Pneumonia: A Case Report and Literature Review. Medicina (B Aires) 2021; 57:medicina57060610. [PMID: 34208316 PMCID: PMC8231184 DOI: 10.3390/medicina57060610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
The long-term administration of vancomycin has increased; however, the pulmonary adverse reactions of long-term vancomycin treatment remain under-studied. A 75-year-old male patient with vertebral osteomyelitis receiving long-term vancomycin therapy developed a fever. High resolution computed tomography showed irregular ground glass opacity and consolidation in the right upper lung. The patient developed organizing pneumonia. This occurred without peripheral eosinophilia or adverse reactions in the skin and liver. The administration of vancomycin was discontinued. He recovered from organizing pneumonia after four weeks of steroid therapy. Solitary organizing pneumonia can develop during treatment with vancomycin. When pulmonary inflammation occurs and other causes of pneumonia are excluded, vancomycin therapy should be discontinued.
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31
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Persistent Post-COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment. Ann Am Thorac Soc 2021; 18:799-806. [PMID: 33433263 PMCID: PMC8086530 DOI: 10.1513/annalsats.202008-1002oc] [Citation(s) in RCA: 264] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Rationale: The natural history of recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment.Objectives: Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV-2 when treated with prednisolone.Methods: A structured assessment protocol screened for sequelae of SARS-CoV-2 pneumonitis. Eight hundred thirty-seven patients were assessed by telephone 4 weeks after discharge. Those with ongoing symptoms had outpatient assessment at 6 weeks. Thirty patients diagnosed with persistent interstitial lung changes at a multidisciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, nonimproving symptoms.Results: At 4 weeks after discharge, 39% of patients reported ongoing symptoms (325/837) and were assessed. Interstitial lung disease, predominantly organizing pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation [SD] ± 27.6, P < 0.001), and forced vital capacity of 9.6% (SD ± 13.0, P = 0.014), with significant symptomatic and radiological improvement.Conclusions: Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. These preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV-2 infection.
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32
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Fernandes AL, Ferro A, dos Santos J, Seabra B. A rare cause of secondary organising pneumonia. BMJ Case Rep 2021; 14:14/3/e241737. [PMID: 33674302 PMCID: PMC7938981 DOI: 10.1136/bcr-2021-241737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Non-tuberculous mycobacterial pulmonary disease may have different clinical manifestations. We report a case of a 64-year-old woman presenting with persistent respiratory complaints, fever and radiological findings. Initially, she was diagnosed with community-acquired pneumonia, but after being submitted to an extensive investigation, including CT-guided transthoracic lung biopsy, a diagnosis of organising pneumonia (OP) was established. The patient was treated with corticosteroids with no favourable response. Subsequently, Mycobacterium avium complex (MAC) was identified in bronchoalveolar lavage culture. The patient was diagnosed with OP secondary to MAC infection and specific antibiotic treatment was initiated. This case represents an infrequent association and illustrates how important it is to investigate primary causes of OP to obtain a satisfactory treatment response.
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Affiliation(s)
| | - Ana Ferro
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Joana dos Santos
- Pathology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Bárbara Seabra
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal,Outpatient Clinic for Tuberculosis and Nontuberculous Mycobacteria, Matosinhos, Portugal
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33
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Ng D, Hamilton GS, Hu E, Lau KK. Micronodular pattern organising pneumonia mimicking miliary lung disease: a rare radiological presentation. BMJ Case Rep 2021; 14:14/2/e239856. [PMID: 33622750 PMCID: PMC7903078 DOI: 10.1136/bcr-2020-239856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Organising pneumonia (OP) is an interstitial lung disease characterised by granulation tissues in alveoli and alveolar ducts. Typical imaging findings are migratory airspace opacities with peripheral or peribronchovascular distribution. Diffuse micronodular OP (MNOP) is a rare imaging manifestation, which has imaging differential diagnosis of endobronchial infection such as tuberculosis, hypersensitivity pneumonitis and respiratory bronchiolitis. Although clinical and ancillary radiological findings may aid in refining the differential diagnosis, histopathological assessment is frequently required for this rare presentation due to implications of treatment and prognosis. We report a case of MNOP and performed a review of the literature.
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Affiliation(s)
- David Ng
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia .,School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Garun S Hamilton
- Department of Respiratory and Sleep Medicine, Monash Health, Clayton, Victoria, Australia
| | - Eric Hu
- Department of Pathology, Monash Health, Clayton, Victoria, Australia
| | - Kenneth K Lau
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia,School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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34
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Chong WH, Saha BK, Austin A, Chopra A. The Significance of Subpleural Sparing in CT Chest: A State-of-the-Art Review. Am J Med Sci 2021; 361:427-435. [PMID: 33487401 DOI: 10.1016/j.amjms.2021.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/03/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022]
Abstract
The subpleural sparing pattern is a common finding on computed tomography (CT) of the lungs. It comprises of pulmonary opacities sparing the lung peripheries, typically 1cm and less from the pleural surface. This finding has a variety of causes, including idiopathic, inflammatory, infectious, inhalational, cardiac, traumatic, and bleeding disorders. Specific disorders that can cause subpleural sparing patterns include nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), pulmonary alveolar proteinosis (PAP), diffuse alveolar hemorrhage (DAH), vaping-associated lung injury (VALI), cracked lung, pulmonary edema, pneumocystis jirovecii pneumonia (PJP), pulmonary contusion, and more recently, Coronavirus disease 2019 (COVID-19) pneumonia. Knowledge of the many etiologies of this pattern can be useful in preventing diagnostic errors. In addition, although the etiology of subpleural sparing pattern is frequently indistinguishable during an initial radiologic evaluation, the differences in location of opacities in the lungs, as well as the presence of additional radiologic findings, patient history, and clinical presentation, can often be useful to suggest the appropriate diagnosis. We did a comprehensive search on Pubmed and Google Scholar database using keywords of "subpleural sparing," "peripheral sparing," "sparing of peripheries," "CT chest," "chest imaging," and "pulmonary disease." This review aims to describe the primary differential diagnosis of subpleural sparing pattern seen on chest imaging with a strong emphasis on clinical and radiographic findings. We also discuss the pathogenesis and essential clues that are crucial to narrow the differential diagnosis.
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Affiliation(s)
- Woon H Chong
- Department of Pulmonary and Critical Care, Albany Medical Center, Albany, New York.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, Missouri
| | - Adam Austin
- Department of Pulmonary and Critical Care, University of Florida, Gainesville, Florida
| | - Amit Chopra
- Department of Pulmonary and Critical Care, Albany Medical Center, Albany, New York
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35
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Faisal M, Roslan A, Nik Abeed NN, Ban Yu-Lin A. Disease-modifying antirheumatic drugs and organising pneumonia. BMJ Case Rep 2021; 14:14/1/e238173. [PMID: 33408105 PMCID: PMC7789045 DOI: 10.1136/bcr-2020-238173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Organising pneumonia (OP) in rheumatoid arthritis (RA) may be part of pulmonary manifestation (disease related) or disease-modifying antirheumatic drugs (DMARDs) related. We report a case series of RA patients with DMARDs related OP. A 65-year-old woman developed OP 3 weeks after initiation of methotrexate (MTX). High-resolution CT (HRCT) scan of the thorax revealed bilateral consolidations in the lung bases. She had complete radiological resolution 6 months after corticosteroid therapy with cessation of MTX. The second case was of a 60-year-old woman on MTX with recent addition of leflunomide due to flare of RA. She developed worsening cough 4 months later and HRCT scan revealed consolidation in the left upper lobe with biopsy proven OP. She responded within 6 months of corticosteroid therapy with clinical and radiological resolution. This case series highlights that OP may developed with low-dose MTX (as early as 3 weeks) and leflunomide and the diagnosis requires a high index of suspicion.
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Affiliation(s)
- Mohamed Faisal
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Asyraf Roslan
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Nik Nuratiqah Nik Abeed
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Andrea Ban Yu-Lin
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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36
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Marwah V, Peter DK, Sharma N, Bhattacharjee S, Hegde A, Shelly D, Malik V, Bhati G, Singh S. Clinico-etiological characteristics of organizing pneumonia: A retrospective study. Lung India 2021; 38:144-148. [PMID: 33687008 PMCID: PMC8098885 DOI: 10.4103/lungindia.lungindia_105_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction: Organizing pneumonia (OP) is an idiopathic interstitial pneumonia characterized radiologically by the patchy peripheral areas of ground-glass opacities and consolidation. It is commonly associated with a variety of conditions such as connective tissue diseases (CTD), drugs, infections, malignancy, radiation exposure, post-transplant, and other interstitial pneumonia. There are no specific clinical manifestations unless there is an underlying etiology. We present a series of such cases. Aims and Objectives: The aim of the study was to identify the clinical characteristics and etiological spectrum of patients manifesting radiologically with OP pattern. Materials and Methods: This was a retrospective analysis of clinico-radiological profile and etiological diagnosis of 23 patients, who had a radiological diagnosis of OP during the period of January 2017–September 2019. Results: Our patients presented with nonspecific symptoms of cough, fever, breathlessness, and occasionally with hemoptysis. The various etiologies identified were CTD (n = 4), infection (n = 2), drugs (n = 4), radiation (n = 1), chronic aspiration syndrome (n = 1), malignancy (n = 2), hypersensitivity pneumonitis (n = 1), and chronic heart failure (n = 2), and in majority (n = 7), no underlying etiology was evident and were labeled as cryptogenic organizing pneumonia. Conclusion: OP is an underdiagnosed entity and is associated with numerous diseases varying from pulmonary tuberculosis to malignancy. Identification of the underlying disease process is of paramount importance as it enables the treating physician to implement necessary therapeutic interventions.
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Affiliation(s)
- Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardio Thoracic Sciences (AI CTS), Pune, Maharashtra, India
| | - Deepu K Peter
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardio Thoracic Sciences (AI CTS), Pune, Maharashtra, India
| | - Neeraj Sharma
- Medical Division, Command Hospital (EC), Kolkata, West Bengal, India
| | - Saikat Bhattacharjee
- Department of Radiology, Army Institute of CardioThoracic Sciences (AI CTS), Pune, Maharashtra, India
| | - Arun Hegde
- Department of Medicine, Command Hospital (SC), Pune, Maharashtra, India
| | - Divya Shelly
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Virender Malik
- Department of Radiology, Army Institute of CardioThoracic Sciences (AI CTS), Pune, Maharashtra, India
| | - Gaurav Bhati
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardio Thoracic Sciences (AI CTS), Pune, Maharashtra, India
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Mrigpuri P, Ranga V, Gupta A, Spalgais S. Organizing pneumonia as preliminary presentation of rheumatoid arthritis: A case report and review of literature. THE JOURNAL OF ASSOCIATION OF CHEST PHYSICIANS 2021. [DOI: 10.4103/jacp.jacp_35_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Dole S, Bagrecha M, Sahasrabudhe T, Barthwal MS. Organizing pneumonia as a presentation of connective tissue disorders. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_408_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hanfi SH, Lalani TK, Saghir A, McIntosh LJ, Lo HS, Kotecha HM. COVID-19 and its Mimics: What the Radiologist Needs to Know. J Thorac Imaging 2021; 36:W1-W10. [PMID: 32852419 DOI: 10.1097/rti.0000000000000554] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current outbreak of Coronavirus disease 2019 (COVID-19). Although imaging should not be used for first-line screening or diagnosis, radiologists need to be aware of its imaging features, and those of common conditions that may mimic COVID-19 pneumonia. In this Pictorial Essay, we review frequently encountered conditions with imaging features that overlap with those that are typical of COVID-19 (including other viral pneumonias, chronic eosinophilic pneumonia, and organizing pneumonia), and those with features that are indeterminate for COVID-19 (including hypersensitivity pneumonitis, pneumocystis pneumonia, diffuse alveolar hemorrhage, pulmonary edema, and pulmonary alveolar proteinosis).
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Affiliation(s)
- Sameer H Hanfi
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
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40
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Álvarez Vega P, Apilánez Tomás J, Jiménez Jurado I, Domínguez Iglesias F, López Suárez RY, Jiménez Jurado A. Pulmonary infiltrates and cough. An unexpected end. Rev Clin Esp 2020; 220:597-602. [PMID: 32115193 DOI: 10.1016/j.rce.2019.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 10/24/2022]
Affiliation(s)
- P Álvarez Vega
- Servicio de Neumología, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España.
| | - J Apilánez Tomás
- Servicio de Neumología, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
| | - I Jiménez Jurado
- Servicio de Neumología, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
| | - F Domínguez Iglesias
- Servicio de Anatomía Patológica, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
| | - R Y López Suárez
- Servicio de Radiodiagnóstico, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
| | - A Jiménez Jurado
- Servicio de Aparato Digestivo, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
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41
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Pulmonary infiltrates and cough. An unexpected end. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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42
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Organizing Pneumonia as a Manifestation of AIDS in a Patient With Partially Treated Pneumocystis Jiroveci Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ito A, Ishida T, Tachibana H, Arita M, Yamazaki A, Washio Y. Utility of procalcitonin for differentiating cryptogenic organising pneumonia from community-acquired pneumonia. Clin Chem Lab Med 2020; 57:1632-1637. [PMID: 31120857 DOI: 10.1515/cclm-2019-0175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/23/2019] [Indexed: 11/15/2022]
Abstract
Background This study aimed to investigate the usefulness of inflammatory biomarkers such as white blood cell (WBC) count, C-reactive protein (CRP) and procalcitonin (PCT) for differentiating cryptogenic organising pneumonia (COP) from community-acquired pneumonia (CAP). Methods COP patients hospitalised in Kurashiki Central Hospital between January 2010 and December 2017 whose WBC counts and CRP and PCT levels were measured were investigated retrospectively, and their results were compared with those of hospitalised CAP patients who were prospectively enrolled between October 2010 and November 2017. Definite COP was defined by specific histopathological findings, and possible COP was defined as a consolidation shadow on chest computed tomography and lymphocyte dominance in bronchoalveolar lavage fluid in the absence of specific histopathological findings or lung specimens. The discriminatory abilities of WBC counts, CRP and PCT were evaluated by receiver operating characteristic (ROC) curve analysis. Results There were 56 patients in the entire COP group, 35 (61.4%) with definite COP, and 914 CAP patients. All three biomarkers were significantly lower in COP than in CAP. The AUC value of PCT in all COP patients was 0.79, significantly higher than of both CRP (AUC 0.59, p < 0.001) and WBC (AUC 0.69, p = 0.048). In definite COP patients, the AUC value of PCT was 0.79, which was also significantly higher than of both WBC (AUC 0.64, p = 0.006) and CRP (AUC 0.64, p = 0.001). Conclusions PCT is a more useful biomarker for differentiating COP from CAP than WBC count or CRP. However, PCT should be used as an adjunct to clinical presentation and radiological findings.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa, Kurashiki 710-8602, Japan, Phone: +81 86 422 0210, Fax: +81 86 421 3424
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiromasa Tachibana
- Department of Respiratory Medicine, National Hospital Organization, Minami Kyoto Hospital, Joyo, Japan
| | - Machiko Arita
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akio Yamazaki
- Department of Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Yasuyoshi Washio
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Zhang G, Cao Y, Zhang J, Zhao Z, Zhang W, Huang L, Zhang Z, Zhou J. Focal organizing pneumonia in patients: differentiation from solitary bronchioloalveolar carcinoma using dual-energy spectral computed tomography. Am J Transl Res 2020; 12:3974-3983. [PMID: 32774750 PMCID: PMC7407697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the utility of dual-energy spectral computed tomography (CT) in the differential diagnosis of focal organizing pneumonia (FOP) and solitary bronchioloalveolar carcinoma (S-BAC). MATERIALS AND METHODS The institutional review board approved this study and waived the requirement for informed consent. It is a retrospective study. A total of 105 patients (62 with FOP and 43 with S-BAC) enrolled and all patients have contrast enhanced spectral CT including the arterial phase (AP) and venous phase (VP). During AP and VP, CT40 keV, CT70 keV, and CT100 keV values, iodine concentration (IC), water concentration (WC), and effective atomic number (Zeff) were measured on monochromatic and iodine-based material decomposition images, and the slope of the spectral curve (λHu) was calculated. The two-sample t-test was used to compare quantitative parameters, and receiver operating characteristic (ROC) curves were generated to calculate diagnostic efficacies. RESULTS For AP, CT40 keV and CT70 keV values, IC, WC, Zeff, λ70 keV, and λ100 keV measurements, there were significantly higher in patients with S-BAC than in those with FOP (P < 0.05). However, these quantitative parameters of VP were significantly lower in patients with S-BAC than in those with FOP (P < 0.05). ROC curve analysis revealed that the combination of all quantitative parameters in AP and VP provided the best diagnostic performance in distinguishing S-BAC from FOP (area under the ROC curve, 93.1%; sensitivity, 95.3%; specificity, 77.4%). CONCLUSIONS Dual-energy spectral CT has the potential to identify S-BAC and FOP.
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Affiliation(s)
- Guojin Zhang
- Second Clinical School, Lanzhou UniversityLanzhou, China
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou, China
| | - Yuntai Cao
- Second Clinical School, Lanzhou UniversityLanzhou, China
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou, China
| | - Jing Zhang
- Second Clinical School, Lanzhou UniversityLanzhou, China
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou, China
| | - Zhiyong Zhao
- Second Clinical School, Lanzhou UniversityLanzhou, China
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou, China
| | - Wenjuan Zhang
- Second Clinical School, Lanzhou UniversityLanzhou, China
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou, China
| | - Lele Huang
- Second Clinical School, Lanzhou UniversityLanzhou, China
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou, China
| | - Zhuoli Zhang
- Department of Radiology, Northwestern UniversityChicago, USA
| | - Junlin Zhou
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou, China
- Department of Radiology, Lanzhou University Second HospitalLanzhou, China
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Diagnostic approach of fibrosing interstitial lung diseases of unknown origin. Presse Med 2020; 49:104021. [PMID: 32437843 DOI: 10.1016/j.lpm.2020.104021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/03/2020] [Indexed: 12/25/2022] Open
Abstract
Interstitial lung diseases encompass a broad range of numerous individual conditions, some of them characterized histologically by fibrosis, especially idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, chronic hypersensitivity pneumonia, interstitial lung disease associated with connective tissue diseases, and unclassifiable interstitial lung disease. The diagnostic approach relies mainly on the clinical evaluation, especially assessment of the patient's demographics, history, smoking habits, occupational or domestic exposures, use of drugs, and on interpretation of high-quality HRCT of the chest. Imaging is key to the initial diagnostic approach, and often can confirm a definite diagnosis, particularly a diagnosis of idiopathic pulmonary fibrosis when showing a pattern of usual interstitial pneumonia in the appropriate context. In other cases, chest HRCT may orientate toward an alternative diagnosis and appropriate investigations to confirm the suspected diagnosis. Autoimmune serology helps diagnosing connective disease. Indications for bronchoalveolar lavage and for lung biopsy progressively become more restrictive, with better considerations for their discriminate value, of the potential risk associated with the procedure, and of the anticipated impact on management. Innovative techniques and genetics are beginning to contribute to diagnosing interstitial lung disease and to be implemented routinely in the clinic. Multidisciplinary discussion, enabling interaction between pulmonologists, chest radiologists, pathologists and often other healthcare providers, allows integration of all information available. It increases the accuracy of diagnosis and prognosis prediction, proposes a first-choice diagnosis, may suggest additional investigations, and often informs the management. The concept of working diagnosis, which can be revised upon additional information being made available especially longitudinal disease behaviour, helps dealing with diagnostic uncertainty inherent to interstitial lung diseases and facilitates management decisions. Above all, the clinical approach and how thoroughly the patient's history and possible exposures are assessed determine the possibility of an accurate diagnosis.
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Tiralongo F, Palermo M, Distefano G, Vancheri A, Sambataro G, Torrisi SE, Galioto F, Ferlito A, Fazio G, Foti PV, Mauro LA, Vancheri C, Palmucci S, Basile A. Cryptogenic Organizing Pneumonia: Evolution of Morphological Patterns Assessed by HRCT. Diagnostics (Basel) 2020; 10:diagnostics10050262. [PMID: 32365469 PMCID: PMC7277545 DOI: 10.3390/diagnostics10050262] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023] Open
Abstract
To evaluate the radiological findings in patients with cryptogenic organizing pneumonia (COP) before steroid treatment and their behavior after therapy, we retrospectively evaluated a total of 22 patients with a diagnosis of COP made by bronchoalveolar lavage (BAL), biopsy or clinical/radiological features, and the patients were followed between 2014 and 2018 at the hospital; the demographic data, symptoms, radiologic findings, diagnostic methods and treatment plans of patients were collected from patients’ hospital records. At least two CT scans of 22 patients (16 female and six men) were evaluated, the first one before starting steroid therapy and the others after therapy. At baseline CT scans, the most common radiological finding was the presence of consolidations (18/22 patients, 81.8%); ground-glass opacities were also very common (15/25, 68.1%). The other findings were as follows: nodules and masses (5/22, 22.7%), atoll sign (4/22, 18.1%), perilobular pattern (3/22, 13.6%) and parenchymal bands (3/22, 13.6%). Two patients had a significant relapse after reducing/interrupting therapy, while three had a complete resolution and are not currently under therapy (maintenance of clinical remission with no oral corticosteroid (OCS)). In High-resolution computed tomography (HRCT) scans after therapy, consolidations were still observable in seven patients (five in new areas of the lung-migratory infiltrates), while most of them disappeared, leaving a residual area of ground glass opacity in two patients. One patient had a residual of the perilobular pattern, with the disappearing of the other findings (consolidations and ground-glass opacities). Two patients developed a fibrosing pattern despite the therapy (9.5%). Cryptogenic organizing pneumonia tends to respond to oral corticosteroid treatment, but some patients may have a null or partial response. We highlight the behavior of this disease after proper therapy.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Monica Palermo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Giulio Distefano
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Ada Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Dept. of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Dept. of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Artroreuma S.R.L., Outpatient of Rheumatology associated with the National Health System, Corso S. Vito 53, 95030 Mascalucia (Catania), Italy
| | - Sebastiano Emanuele Torrisi
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Dept. of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Federica Galioto
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Agata Ferlito
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Giulia Fazio
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Pietro Valerio Foti
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Letizia Antonella Mauro
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Dept. of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
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Wang Z, Wu C, Zhu R, Chen Z, Sun Z, Ma Q, Ji N, Huang M, Zhang M. Airway invasive aspergillosis with organizing pneumonia: a case report and review of literature. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:504. [PMID: 32395548 PMCID: PMC7210130 DOI: 10.21037/atm.2020.03.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Organizing pneumonia (OP) is a distinct clinical and pathologic entity. This condition can be cryptogenic (COP) or secondary to other known causes (secondary OP, SOP). Concomitant occurrence of invasive pulmonary aspergillosis (IPA) with SOP is unusual. Here, we report a case where SOP was a presenting feature in a patient with diagnosed IPA. A previously healthy 62-year-old man presented to the hospital with a month of intermittent fever accompanied by cough and expectoration. According to computed tomography (CT), sputum culture, and transbronchial lung biopsy, he was diagnosed as IPA. Despite undergoing voriconazole and dexamethasone therapy, the patient's condition did not improve after three weeks of therapy. CT-guided percutaneous lung biopsy performed in the left upper lung showed invasive airway aspergillosis with organizing pneumonia. Two months after the combination therapy of voriconazole and methylprednisolone, the CT scan indicated the pulmonary consolidations were almost entirely resolved. To the best of our knowledge, this is the first case of successful non-surgical treatment of IPA with SOP. In a review of the literature, we aimed to highlight the possibility of invasive airway aspergillosis concurrent with secondary organizing pneumonia. Physicians should be aware of the possibility of SOP in the case of IPA.
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Affiliation(s)
- Zhengxia Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chaojie Wu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ranran Zhu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhongqi Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhixiao Sun
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qiyun Ma
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ningfei Ji
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Mao Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Mingshun Zhang
- NHC Key Laboratory of Antibody Technique, Department of Immunology, Nanjing Medical University, Nanjing 211166, China
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Cho YH, Chae EJ, Song JW, Do KH, Jang SJ. Chest CT imaging features for prediction of treatment response in cryptogenic and connective tissue disease-related organizing pneumonia. Eur Radiol 2020; 30:2722-2730. [PMID: 32040727 DOI: 10.1007/s00330-019-06651-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate CT imaging features associated with poor clinical outcome after corticosteroid treatment in patients diagnosed with cryptogenic organizing pneumonia (COP) and connective tissue disease-related organizing pneumonia (CTD-OP) and to assess the difference in CT findings and treatment responses between COP and CTD-OP. METHODS Chest CT images from 166 patients (COP, 131; CTD-OP, 35) with pathologically proven organizing pneumonia were reviewed by two thoracic radiologists. The type, distribution pattern, and extent of parenchymal abnormalities, along with other associated imaging features, were assessed for each patient. Logistic regression analyses were used to identify features associated with poor clinical outcomes such as residual disease (RD) and disease relapse. The differences between COP and CTD-OP were also analyzed. RESULTS Consolidation involving more than 10% of parenchyma (hazard ratio [HR], 2.27), detectable bronchiectasis (HR, 3.59), and diagnosis of CTD-OP (HR, 4.31) were associated with a higher risk of RD after adjustments for patient age and sex. More than 10% consolidation involvement (HR, 2.54) and diagnosis of CTD-OP (HR, 6.42) were also associated with a higher risk of disease relapse. Compared with COP, CTD-OP demonstrated a greater extent of parenchymal abnormalities, especially consolidation, and was less likely to show a peribronchovascular distribution pattern. CONCLUSION Bronchiectasis and a greater extent of consolidation were associated with RD, with the latter also being associated with disease relapse. Compared with COP, CTD-OP was associated with worse treatment outcomes and demonstrated a greater extent of parenchymal abnormalities, which were also less likely to show a peribronchovascular pattern. KEY POINTS • The presence of bronchiectasis and a high parenchymal involvement of consolidation on initial chest CT were associated with a worse response to corticosteroids in patients with organizing pneumonia. • Connective tissue disease-related organizing pneumonia (CTD-OP) was associated with worse treatment outcomes than its idiopathic counterpart cryptogenic organizing pneumonia (COP). • Compared with COP, CTD-OP generally demonstrated a greater extent of parenchymal abnormalities, especially consolidation, and was less likely to show a peribronchovascular distribution pattern.
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Affiliation(s)
- Young Hoon Cho
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Eun Jin Chae
- Department of Thoracic Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung-Hyun Do
- Department of Thoracic Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Se Jin Jang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Cryptogenic Organizing Pneumonia with a Rare Radiographic Presentation of a Diffuse Micronodular Pattern Mimicking Miliary Lung Infiltration: A Case Report and Review of the Literature. Case Rep Pulmonol 2020; 2020:2094625. [PMID: 31976111 PMCID: PMC6961601 DOI: 10.1155/2020/2094625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 01/15/2023] Open
Abstract
We reported a case of cryptogenic organizing pneumonia (COP) presenting with an unusual diffuse micronodular pattern (DMP) mimicking miliary lung infiltration. The patient is a 66-year-old man with a past medical history of diabetes mellitus type 2 and hyperlipidemia who presented with progressive dyspnea associated with significant weight loss and night sweats for 2 weeks. Upon admission, the patient's clinical condition rapidly progressed to respiratory failure requiring mechanical ventilation. Initial Chest X-ray (CXR) showed diffuse reticulonodular infiltration mimicking miliary pattern. Chest computed tomography (CT) showed diffuse centrilobular micronodular infiltrations with features of a tree-in-bud pattern consistent with the CXR findings. He was then started on empiric antibiotics for community-acquired pneumonia and underwent a diagnostic bronchoscopy with alveolar lavage and transbronchial biopsies, which yielded negative cultures and unrevealing pathology. Tissue from CT-guided lung biopsy performed later on was also inconclusive. Due to the lack of clinical improvement, he eventually underwent surgical lung biopsy. The pathology result showed organizing pneumonia (OP) pattern with heavy lymphoplasmacytic infiltrates and numerous multinucleated giant cells. His final culture results, microbiological data and serology workup for autoimmune disease were all unremarkable. The patient was diagnosed with COP and was started on systemic corticosteroids. He displayed dramatic clinical improvement and was successfully liberated from the ventilator. Subsequent chest imaging showed resolution of the reticulonodular infiltrations. Early diagnosis for OP and ability to distinguish OP from infectious pneumonitides are critical as the majority of patients with OP respond promptly to corticosteroids. Common findings of radiographic pattern for OP are patchy air space consolidation or ground-glass opacity, yet DMP is another rare radiographic pattern that must be recognized, especially in COP. In summary, this case illustrates a rare radiographic presentation of COP. With early recognition and prompt diagnosis, proper treatment can significantly prevent morbidity and reduce mortality.
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50
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Kang SY, Kim SY, Choi SH, Sol IS, Kim YH, Shim HS, Lee MJ, Kim KW, Sohn MH. Organizing pneumonia as the initial presentation of systemic lupus erythematosus in a Korean adolescent. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.3.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- So-Young Kang
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Ha Choi
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - In Suk Sol
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Sup Shim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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