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Hu Y, Zhang C, Jia L. Pneumonia due to Mycobacterium cosmeticum in a patient with systemic sclerosis: A case report. Clin Case Rep 2023; 11:e7464. [PMID: 37273677 PMCID: PMC10238707 DOI: 10.1002/ccr3.7464] [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: 02/26/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023] Open
Abstract
Pulmonary infection due to Mycobacterium cosmeticum was reported in only two patients previously. More studies are warranted to define its characteristics and treatments. We report a systemic sclerosis patient who had a pulmonary infection due to M. cosmeticum and then successfully recovered after treatment with combination antibiotic regimen.
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Affiliation(s)
- Yueqin Hu
- Department of pharmacyYichang Central People's Hospital & The First Clinical Medical College of China Three Gorges UniversityYichangChina
| | - Chao Zhang
- Department of pneumologyYichang Central People's Hospital & The First Clinical Medical College of China Three Gorges UniversityYichangChina
| | - Liangliang Jia
- Department of pharmacyYichang Central People's Hospital & The First Clinical Medical College of China Three Gorges UniversityYichangChina
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Landini N, Orlandi M, Occhipinti M, Nardi C, Tofani L, Bellando-Randone S, Ciet P, Wielopolski P, Benkert T, Bruni C, Bertolo S, Moggi-Pignone A, Matucci-Cerinic M, Morana G, Colagrande S. Ultrashort Echo-Time Magnetic Resonance Imaging Sequence in the Assessment of Systemic Sclerosis-Interstitial Lung Disease. J Thorac Imaging 2023; 38:97-103. [PMID: 35482025 DOI: 10.1097/rti.0000000000000637] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To test respiratory-triggered ultrashort echo-time (UTE) Spiral VIBE-MRI sequence in systemic sclerosis-interstitial lung disease assessment compared with computed tomography (CT). MATERIAL AND METHODS Fifty four SSc patients underwent chest CT and UTE (1.5 T). Two radiologists, independently and in consensus, verified ILD presence/absence and performed a semiquantitative analysis (sQA) of ILD, ground-glass opacities (GGO), reticulations and honeycombing (HC) extents on both scans. A CT software quantitative texture analysis (QA) was also performed. For ILD detection, intra-/inter-reader agreements were computed with Cohen K coefficient. UTE sensitivity and specificity were assessed. For extent assessments, intra-/inter-reader agreements and UTE performance against CT were computed by Lin's concordance coefficient (CCC). RESULTS Three UTE were discarded for low quality, 51 subjects were included in the study. Of them, 42 QA segmentations were accepted. ILD was diagnosed in 39/51 CT. UTE intra-/inter-reader K in ILD diagnosis were 0.56 and 0.26. UTE showed 92.8% sensitivity and 75.0% specificity. ILD, GGO, and reticulation extents were 14.8%, 7.7%, and 7.1% on CT sQA and 13.0%, 11.2%, and 1.6% on CT QA. HC was <1% and not further considered. UTE intra-/inter-reader CCC were 0.92 and 0.89 for ILD extent and 0.84 and 0.79 for GGO extent. UTE RET extent intra-/inter-reader CCC were 0.22 and 0.18. UTE ILD and GGO extents CCC against CT sQA and QA were ≥0.93 and ≥0.88, respectively. RET extent CCC were 0.35 and 0.22 against sQA and QA, respectively. CONCLUSION UTE Spiral VIBE-MRI sequence is reliable in assessing ILD and GGO extents in systemic sclerosis-interstitial lung disease patients.
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Affiliation(s)
- Nicholas Landini
- Department of Radiology, Ca' Foncello General Hospital, Treviso
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Mariaelena Occhipinti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Pierluigi Ciet
- Department of Pediatric Pulmonology, Erasmus University Medical Centre, Sophia Children's Hospital
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Piotr Wielopolski
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Thomas Benkert
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Silvia Bertolo
- Department of Radiology, Ca' Foncello General Hospital, Treviso
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence & Division of Internal Medicine Unit IV AOUC, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello General Hospital, Treviso
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
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3
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Orlandi M, Meliante LA, Damiani A, Tofani L, Bruni C, Guiducci S, Matucci-Cerinic M, Bellando-Randone S, Tomassetti S. The Role of Bronchoalveolar Lavage in Systemic Sclerosis Interstitial Lung Disease: A Systematic Literature Review. Pharmaceuticals (Basel) 2022; 15:ph15121584. [PMID: 36559035 PMCID: PMC9781787 DOI: 10.3390/ph15121584] [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: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstitial lung disease (ILD) is still controversial. The aim of this systematic literature review was to investigate the use of BAL in SSc-ILD, and to focus on the pros and cons of its real-life application. Methods: PubMed, Cochrane, and Embase were questioned from inception until 31 December 2021. Results: Eighteen papers were finally analyzed. A positive correlation was observed between lung function and BAL cytology; in particular, BAL neutrophilia/granulocytosis was related to lower diffusing capacity for carbon monoxide (DLCO) values and lower forced vital capacity (FVC). Moreover, a positive correlation between BAL cellularity and high-resolution computed tomography (HRCT) findings has been reported by several authors. Cytokines, chemokines, growth factors, coagulation factors, and eicosanoids have all been shown to be present, more often and in higher quantities in SSc-ILD patients than in the health control and, in some cases, they were related to more severe pulmonary disease. There was no consensus regarding the role of BAL cellularity as a predictor of mortality.
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Affiliation(s)
- Martina Orlandi
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Laura Antonia Meliante
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Arianna Damiani
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Lorenzo Tofani
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Cosimo Bruni
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Serena Guiducci
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
- Correspondence: ; Tel.: +39-055-794-7066
| | - Marco Matucci-Cerinic
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Silvia Bellando-Randone
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence, and Division of Interventional Pulmonology, Careggi University Hospital, 50134 Florence, Italy
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4
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Orlandi M, Landini N, Sambataro G, Nardi C, Tofani L, Bruni C, Bellando-Randone S, Blagojevic J, Melchiorre D, Hughes M, Denton CP, Luppi F, Ruaro B, Della Casa F, Rossi FW, De Luca G, Campochiaro C, Spinicci M, Zammarchi L, Tomassetti S, Caminati A, Cavigli E, Albanesi M, Melchiorre F, Palmucci S, Vegni V, Guiducci S, Moggi-Pignone A, Allanore Y, Bartoloni A, Confalonieri M, Dagna L, De Cobelli F, De Paulis A, Harari S, Khanna D, Kuwana M, Taliani G, Lavorini F, Miele V, Morana G, Pesci A, Vancheri C, Colagrande S, Matucci-Cerinic M. THE ROLE OF CHEST CT IN DECIPHERING INTERSTITIAL LUNG INVOLVEMENT: SYSTEMIC SCLEROSIS VERSUS COVID-19. Rheumatology (Oxford) 2021; 61:1600-1609. [PMID: 34320649 DOI: 10.1093/rheumatology/keab615] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify the main computed tomography (CT) features that may help distinguishing a progression of interstitial lung disease (ILD) secondary to Systemic sclerosis (SSc) from COVID-19 pneumonia. METHODS This multicentric study included 22 international readers divided in the radiologist group (RAD) and non-radiologist group (nRAD). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study. RESULTS Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p < 0.0001) and signs of fibrosis in GGO in the lower lobes (p < 0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. A predictive score was created which resulted positively associated with the COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity). CONCLUSION The CT differential diagnosis between COVID-19 pneumonia and SSc-ILD is possible through the combination the proposed score and the radiologic expertise. The presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.
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Affiliation(s)
- Martina Orlandi
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Nicholas Landini
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - AOUC, Largo Brambilla 3, 50134, Florence, Italy.,Department of Radiology, Ca' Foncello General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Dept. ofClinical and Experimental Medicine, University of Catania, Catania, Italy.,Artroreuma S.R.L., Rheumatology Outpatient Clinic Associated with the National Health System, Mascalucia(Catania), Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - AOUC, Largo Brambilla 3, 50134, Florence, Italy
| | - Lorenzo Tofani
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Cosimo Bruni
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Jelena Blagojevic
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Daniela Melchiorre
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Michael Hughes
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Fabrizio Luppi
- Respiratory Unit, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - Francesca Della Casa
- Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences. University ofNaples Federico II, Napoli, Italy
| | - Francesca W Rossi
- Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences. University ofNaples Federico II, Napoli, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Edoardo Cavigli
- SOD Radiodiagnostica Emergenza-Urgenza, AOU Careggi, Florence, Italy
| | - Marco Albanesi
- SOD Radiodiagnostica Emergenza-Urgenza, AOU Careggi, Florence, Italy
| | - Fabio Melchiorre
- Department of Radiology Sant'Andrea Hospital Vercelli, ASLVC Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, Department of Medical Surgical Sciences and Advanced Technologies"GF Ingrassia", University of Catania, Italy
| | | | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, AOU Careggi Hospital, University of Florence MedicalSchool, Florence, Italy
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan,Italy
| | - Amato De Paulis
- Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences. University ofNaples Federico II, Napoli, Italy
| | - Sergio Harari
- U.O. di Pneumologia, Ospedale San Giuseppe MultiMedica, IRCCS.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Gloria Taliani
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Federico Lavorini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Vittorio Miele
- SOD Radiodiagnostica Emergenza-Urgenza, AOU Careggi, Florence, Italy
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Alberto Pesci
- Respiratory Unit, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Dept. ofClinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - AOUC, Largo Brambilla 3, 50134, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
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5
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Zhao Z, He Z, Huang H, Chen J, He S, Yilihamu A, Nie Y. Drug-induced Interstitial Lung Disease in Breast Cancer Patients: A Lesson We Should Learn From Multi-Disciplinary Integration. BIO INTEGRATION 2020. [DOI: 10.15212/bioi-2020-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract Taxanes represented by paclitaxel and targeted therapy including trastuzumab are two common agents for human epidermal growth factor receptor-2 (HER-2)-positive breast cancer patients. Effectiveness, however, usually comes at the cost of many side effects, some of
which are even fatal. Drug-induced interstitial lung diseases (DILDs) comprise a group of drug-induced pulmonary injuries usually caused by using these medications. For DILDs, systemic therapy can be harmful to lung tissues and rapidly threaten the lives of some breast cancer patients. Through
the cases from our hospital and related studies in medical databases, we hope readers can learn a lesson from an angle of multi-disciplinary integration based on clinical practice and pharmacological mechanisms to make anti-cancer agents less harmful and reduce the incidence of DILD in breast
cancer patients during systemic therapy.
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Affiliation(s)
- Zijun Zhao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Zhanghai He
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, P.R. China
| | - Hongyan Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Jiewen Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Shishi He
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Ailifeire Yilihamu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Yan Nie
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
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A Systematic Review of the Role of Dysfunctional Wound Healing in the Pathogenesis and Treatment of Idiopathic Pulmonary Fibrosis. J Clin Med 2016; 6:jcm6010002. [PMID: 28035951 PMCID: PMC5294955 DOI: 10.3390/jcm6010002] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/06/2016] [Accepted: 12/15/2016] [Indexed: 02/06/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disorder showcasing an interaction between genetic predisposition and environmental risks. This usually involves the coaction of a mixture of cell types associated with abnormal wound healing, leading to structural distortion and loss of gas exchange function. IPF bears fatal prognosis due to respiratory failure, revealing a median survival of approximately 2 to 3 years. This review showcases the ongoing progress in understanding the complex pathophysiology of IPF and it highlights the latest potential clinical treatments. In IPF, various components of the immune system, particularly clotting cascade and shortened telomeres, are highly involved in disease pathobiology and progression. This review also illustrates two US Food and Drug Administration (FDA)-approved drugs, nintedanib (OFEV, Boehringer Ingelheim, Ingelheim am Rhein, Germany) and pirfenidone (Esbriet, Roche, Basel, Switzerland), that slow IPF progression, but unfortunately neither drug can reverse the course of the disease. Although the mechanisms underlying IPF remain poorly understood, this review unveils the past and current advances that encourage the detection of new IPF pathogenic pathways and the development of effective treatment methods for the near future.
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Bastos ADL, Corrêa RDA, Ferreira GA. Tomography patterns of lung disease in systemic sclerosis. Radiol Bras 2016; 49:316-321. [PMID: 27818546 PMCID: PMC5094821 DOI: 10.1590/0100-3984.2015.0116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 11/04/2015] [Indexed: 01/30/2023] Open
Abstract
Currently, lung impairment is the leading factor responsible for the morbidity and mortality associated with systemic sclerosis. Therefore, the recognition of the various tomography patterns becomes decisive in the clinical management of these patients. In high-resolution computed tomography studies, the most common pattern is that of nonspecific interstitial pneumonia. However, there are other forms of lung involvement that must also be recognized. The aim of this study was to review the literature on the main changes resulting from pulmonary involvement in systemic sclerosis and the corresponding radiological findings, considering the current classification of interstitial diseases. We searched the Medline (PubMed), Lilacs, and SciELO databases in order to select articles related to pulmonary changes in systemic sclerosis and published in English between 2000 and 2015. The pulmonary changes seen on computed tomography in systemic sclerosis are varied and are divided into three main categories: interstitial, alveolar, and vascular. Interstitial changes constitute the most common type of pulmonary involvement in systemic sclerosis. However, alveolar and vascular manifestations must also be recognized and considered in the presence of atypical clinical presentations and inadequate treatment responses.
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Affiliation(s)
- Andréa de Lima Bastos
- Adjunct Professor in the Department of Anatomy and
Imaging at the Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG),
Belo Horizonte, MG, Brazil
| | - Ricardo de Amorim Corrêa
- Associate Professor in the Department of Clinical
Medicine at the Faculdade de Medicina da Universidade Federal de Minas Gerais
(UFMG), Belo Horizonte, MG, Brazil
| | - Gilda Aparecida Ferreira
- Adjunct Professor in the Department of Locomotor Studies
at the Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo
Horizonte, MG, Brazil
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Reyes LJ, Morell F, Xaubet A, Ramírez J, Majó J. [Nonspecific interstitial pneumonia: epidemiologic and clinical characteristics]. Med Clin (Barc) 2006; 126:47-52. [PMID: 16426543 DOI: 10.1157/13083567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients diagnosed with non-specific interstitial pneumonia (NSIP) in 2 hospitals in Barcelona, Spain, were studied to investigate the factors that could contribute to the etiology of disease. PATIENTS AND METHOD The consensus diagnostic criteria established by the American Thoracic Society/European Respiratory Society were followed. The study included 16 patients, 10 men (65%) and 6 women (35%), all diagnosed with NSIP by open lung biopsy. Patients were questioned on pathological history, occupational or environmental exposure, medicinal drug use, contact with birds, and relationship with smoking. In addition, were recorded symptoms and physical signs, laboratory and respiratory function results, chest X-ray and computerized tomography scan features, fiberbronchoscopy findings and open lung biopsy findings. RESULTS Eleven patients (69%) -10 men (100%) and one woman (12%) -were smokers: 4 were active and 7 former smokers; 8 (80%) patients had fibrotic NSIP and three (50%) had cellular NSIP. Nine (56%) patients had a medication history, and 5 received chronic non-steroideal anti-inflammatory drug treatment. Occupational exposure to bleach, detergents, and ammonia or chloride products was documented in 6 cases. Three patients had contact with manufactured plastic products and isocyanate inhalation. CONCLUSIONS Smoking and medication use were prevalent in NSIP patients. Ibuprofen and celecoxib clearly provoked symptoms in one NSIP patient. Further studies are required to clarify the role of detergents, isocyanates and other occupation-related substances as triggering factors.
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Affiliation(s)
- Leonardo José Reyes
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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9
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Israel-Biet D, Danel C. [Contribution of bronchoalveolar lavage to the management of interstitial lung disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2005; 61:141-8. [PMID: 16142186 DOI: 10.1016/s0761-8417(05)84805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Bronchoalveolar lavage (BAL) is a minimally invasive method for exploring the distal lung. It enables collection of free cellular and acellular material present in the alveoli. Over the last two decades BAL has become a fundamental tool for positive diagnosis of interstitial lung disease and even more for differential diagnosis. It has contributed greatly to the diagnosis of lung infections, particularly in immunosuppressed patients. In the context of non-infectious infiltrative disease, the diagnostic contribution of BAL is limited due to the lack of a specific cell profile. It remains a fundamental tool for the differential diagnosis of idiopathic interstitial pneumonia. With BAL, a number of infectious or tumoral diseases can be ruled out with precision. It is also an important element for the evaluation of possible iatrogenic disease. BAL has transformed the diagnosis of interstitial lung disease and considerably reduced the indications for surgical biopsy.
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Affiliation(s)
- Dominique Israel-Biet
- Service de Pneumologie, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, Faculté de Médecine Paris-5.
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10
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Flieder DB, Koss MN. Nonspecific interstitial pneumonia: a provisional category of idiopathic interstitial pneumonia. Curr Opin Pulm Med 2004; 10:441-6. [PMID: 15316445 DOI: 10.1097/01.mcp.0000133066.94340.f3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Idiopathic interstitial pneumonias (IIP) represent a complex group of relatively rare entities with similar clinical, vaguely similar radiographic and differing histologic features. The recent international multidisciplinary consensus statement produced by the American Thoracic Society/European Respiratory Society aiming to standardize the classification of IIP recognizes nonspecific interstitial pneumonia (NSIP) as a provisional category. While not representing a single disease, but rather a collection of pathologic processes with similar histomorphology, NSIP has been a great source of confusion for pulmonologists, radiologists, and pathologists. RECENT FINDINGS Lacking diagnostic clinical or radiographic features, NSIP is an IIP with recognizable and reproducible morphologic patterns different from usual interstitial pneumonia (UIP)-pattern as well as other disease patterns. And while overlap with UIP-pattern can be seen in individuals with multiple biopsy samples, those with either cellular or fibrosing variants of NSIP have a better prognosis than UIP-pattern patients. SUMMARY A morphologic diagnosis of NSIP-pattern alerts the clinician to a wide spectrum of potential clinical possibilities and enables researchers to study both this fibrosing interstitial pneumonia pattern and the more common and deadly UIP-pattern separately. Thus, this provisional category is useful to both clinicians and researchers.
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Affiliation(s)
- Douglas B Flieder
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York 10021, USA.
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Rottoli P, Bargagli E. Is bronchoalveolar lavage obsolete in the diagnosis of interstitial lung disease? Curr Opin Pulm Med 2003; 9:418-25. [PMID: 12904714 DOI: 10.1097/00063198-200309000-00014] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This review considers the literature on bronchoalveolar lavage in the diagnosis of interstitial lung disease published during the last 12 months with the aim of clarifying the role bronchoalveolar lavage can have in diagnostic work-up on the basis of current knowledge and expert opinion. Recent research findings with possible future clinical applications are presented. Various information, useful for research and clinical applications, can be obtained from performing bronchoalveolar lavage in patients with interstitial lung diseases. Indeed, evaluation of cell pattern associated with cell phenotype is used widely in clinical practice to distinguish the various forms and may be of diagnostic value in some interstitial lung diseases, as already known, when the clinical picture is compatible. Bronchoalveolar lavage may also be complementary to high-resolution CT or at least useful for diagnosis by exclusion. A major advance in the last year is recognition of a role for bronchoalveolar lavage in the diagnostic workup of idiopathic interstitial pneumonias, albeit as an auxiliary procedure. It may be useful to exclude infections and tumors, may help to decide whether to do surgical biopsy, and may aid in distinguishing different forms of interstitial lung disease. Although it is not diagnostic for idiopathic interstitial pneumonias, in the presence of cell patterns considered "typical" of the various forms, it can support clinical diagnosis in the absence of biopsy. Because further studies following standardized protocols and guidelines will presumably find new parameters for bronchoalveolar lavage in the diagnostics of interstitial lung diseases, it would be a mistake to consider bronchoalveolar lavage an obsolete tool.
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Affiliation(s)
- Paola Rottoli
- Division of Respiratory Diseases, Department of Clinical Medicine and Immunological Science, Siena University-Policlinico Le Scotte, Siena, Italy.
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Tobin MJ. Tuberculosis, lung infections, interstitial lung disease, and journalology in AJRCCM 2002. Am J Respir Crit Care Med 2003; 167:345-55. [PMID: 12554623 DOI: 10.1164/rccm.2212002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA.
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