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Acharya S, Aryal R, Yadav RK, Shrestha S, Karki R, Jha S. Organizing pneumonia as an initial presentation in a male lupus: A rare case report. Clin Case Rep 2023; 11:e7389. [PMID: 37215971 PMCID: PMC10196426 DOI: 10.1002/ccr3.7389] [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: 04/03/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Organizing pneumonia (OP) is one of the rare pulmonary manifestations of systemic lupus erythematosus (SLE) which is infrequently reported as a presenting manifestation. Early diagnosis of lupus-related OP with the help of imaging, can drive to prompt initiation of immunosuppressive therapy leading to a better prognosis. We present a case of a 34-year-old young male who presented with fever, myalgia, and a dry cough for 1 month and was later diagnosed as SLE-related organizing pneumonia.
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Affiliation(s)
- Suman Acharya
- Department of Internal MedicineTribhuvan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Roshan Aryal
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | | | - Suraj Shrestha
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Rikesh Karki
- Kathmandu Medical College and Teaching HospitalKathmanduNepal
| | - Saket Jha
- Department of Internal MedicineTribhuvan University Teaching Hospital, Institute of MedicineKathmanduNepal
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Ito Y, Tamada T, Okunishi Y, Mizutani S, Yamamoto Y, Nakajima A. Organizing pneumonia as a possible pulmonary manifestation of systemic lupus erythematosus: Three cases and a review of literature. Lupus 2022; 31:737-743. [PMID: 35341381 DOI: 10.1177/09612033221088177] [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: 11/17/2022]
Abstract
Background: Organizing pneumonia (OP) is a rare manifestation of systemic lupus erythematosus (SLE). It has been described in very few case reports.Purpose and Methods: We encountered OP in three patients with SLE in 1 year; two manifested OP as an initial presentation of SLE, while the third manifested OP when SLE relapsed. To elucidate the clinical features and outcomes of OP in patients with SLE, we screened the PubMed database for cases diagnosed with OP either at or after the diagnosis of SLE; the search was restricted to articles that were published after 1990, when OP became widely recognized.Results: We identified 15 cases of OP in patients with SLE. Thus, we analyzed a total of 18 cases (including our three). OP developed at the initial diagnosis of SLE in 15 cases and at relapse of SLE in three cases. In most cases, the disease activity of SLE was moderate or high. In all cases, OP was accompanied by other extrapulmonary symptoms of SLE, namely, fever (77.8%), cutaneous manifestations (61.1%), arthralgia/arthritis (50%), and lupus nephritis (33.3%). Steroid monotherapy or increasing the dose of the steroids was effective in seven cases (38.8%); however, steroid monotherapy was ineffective and led to death due to respiratory failure in two cases (11.1%). Combination therapies of steroids with hydroxychloroquine, azathioprine, tacrolimus, mycophenolate mofetil, intravenous pulse cyclophosphamide therapy, and belimumab were effective in seven cases (38.8%).Conclusions: Based on the review of previously reported and our cases, we concluded that OP is an important pulmonary manifestation of SLE. Clinicians should be aware of it as it may require intensive immunosuppressive therapy either at or after the diagnosis of SLE.
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Affiliation(s)
- Yuhei Ito
- Center for Rheumatic Diseases, 220937Mie University Hospital, Tsu, Japan
| | - Tatsuya Tamada
- Center for Rheumatic Diseases, 220937Mie University Hospital, Tsu, Japan
| | - Yuki Okunishi
- Center for Rheumatic Diseases, 220937Mie University Hospital, Tsu, Japan
| | - Satoshi Mizutani
- Center for Rheumatic Diseases, 220937Mie University Hospital, Tsu, Japan
| | - Yoshiki Yamamoto
- Center for Rheumatic Diseases, 220937Mie University Hospital, Tsu, Japan
| | - Ayako Nakajima
- Center for Rheumatic Diseases, 220937Mie University Hospital, Tsu, Japan
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Di Bartolomeo S, Alunno A, Carubbi F. Respiratory Manifestations in Systemic Lupus Erythematosus. Pharmaceuticals (Basel) 2021; 14:276. [PMID: 33803847 PMCID: PMC8003168 DOI: 10.3390/ph14030276] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by a wide spectrum of clinical manifestations. The respiratory system can be involved in up to 50-70% of patients and be the presenting manifestation of the disease in 4-5% of cases. Every part of the respiratory part can be involved, and the severity can vary from mild self-limiting to life threatening forms. Respiratory involvement can be primary (caused by SLE itself) or secondary (e.g., infections or drug toxicity), acute or chronic. The course, treatment and prognosis vary greatly depending on the specific pattern of the disease. This review article aims at providing an overview of respiratory manifestations in SLE along with an update about therapeutic approaches including novel biologic therapies.
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Affiliation(s)
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, 06123 Perugia, Italy;
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila and Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, 67100 L’Aquila, Italy
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Kröner PT, Lee A, Farraye FA. Respiratory Tract Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:563-574. [PMID: 32448912 DOI: 10.1093/ibd/izaa112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease can manifest in many extraintestinal organ systems. The most frequently involved extraintestinal locations include the mucocutaneous, hepatobiliary, and ocular organ systems. The respiratory tract is less commonly involved and is therefore frequently overlooked. Consequently, it is believed that involvement of the respiratory tract in patients with inflammatory bowel disease is underreported. The pathogenesis is thought to be multifactorial, involving the common embryologic origin shared by the respiratory and luminal digestive tract, molecular mimicry, and immunologic interactions leading to immune-complex deposition in affected tissue. The spectrum of manifestations of the respiratory tract related to inflammatory bowel disease is broad. It not only includes direct involvement of the respiratory tract (ie, airways, interstitium, and pleura) but also can result as a consequence of systemic involvement such as in thromboembolic events. In addition, it may also be related to other conditions that affect the respiratory tract such as sarcoidosis and alpha-1 antitrypsin deficiency. Though some conditions related to respiratory tract involvement might be subclinical, others may have life-threatening consequences. It is critical to approach patients with suspected inflammatory bowel disease-related respiratory tract involvement in concert with pulmonology, infectious diseases, and any other pertinent experts, as treatments may require a multidisciplinary overlap of measures. Therefore, it is of paramount importance for the clinician to be aware of the array of respiratory tract manifestations of patients with inflammatory bowel disease, in addition to the possible spectrum of therapeutic measures.
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Affiliation(s)
- Paul T Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Augustine Lee
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
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Baisya R, Devarasetti PK, Uppin SG, Narayanan R, Rajasekhar L, Sreejitha KS. Bronchiolitis obliterans organizing pneumonia as the pulmonary manifestation of lupus: A review of three cases. Lupus 2020; 30:336-341. [PMID: 33103988 DOI: 10.1177/0961203320967439] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Bronchiolitis obliterans organizing pneumonia (BOOP) is a clinico-patho-radiological diagnosis which rarely presents as a pulmonary manifestation of lupus. In this concise report, organizing pneumonia was found as the sole pulmonary manifestation of SLE in different age groups. METHOD All three patients diagnosed with SLE according to SLICC 2012 classification criteria, were admitted in rheumatology ward of NIMS hospital, Hyderabad, India from May to November, 2018. Their diagnosis of BOOP was either biopsy proven or imaging guided. Review of literature was done with MeSH terms (SLE, BOOP) in PubMed and approximately 10 articles were reviewed including latest of 2019 published in Scientific Reports. RESULT There were three patients - one juvenile lupus and two adults. Two patients were male and one female. All three patients had SLE with high disease activity. They all had organising pneumonia as pulmonary manifestation with other organ involvement. Juvenile patient had a fatal outcome while the others had a good recovery with steroid and immunosuppressive. CONCLUSION BOOP is a rare pulmonary manifestation in lupus. It can be diagnosed early with more precision using computerised tomography of lung without waiting for biopsy report. This will result in a better prognosis by rapid initiation of corticosteroid and immunosuppressive treatment.
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Affiliation(s)
- Ritasman Baisya
- Department of Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
| | - Phani Kumar Devarasetti
- Department of Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
| | - Shantveer G Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
| | - Ramakrishna Narayanan
- Department of Radiology & Imageology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
| | - Liza Rajasekhar
- Department of Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
| | - K S Sreejitha
- Department of Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
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Chen Y, Wang Y, Chen X, Liang H, Yang X. Association of Interstitial Lung Disease With Clinical Characteristics of Chinese Patients With Systemic Lupus Erythematosus. Arch Rheumatol 2020; 35:239-246. [PMID: 32851373 DOI: 10.46497/archrheumatol.2020.7583] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/16/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives This study aims to evaluate the frequency and clinical and laboratory features of interstitial lung disease (ILD) in Chinese patients with systemic lupus erythematosus (SLE) and to evaluate the association of ILD with the clinical features. Patients and methods The study included 505 SLE patients (64 males, 441 females; mean age 35.3±15.3 years; range, 14 to 87 years) who were categorized into two groups as 449 patients without ILD and 56 patients with ILD based on evidence obtained from high-resolution computed tomography images. The demographic data, clinical and laboratory findings, SLE disease activity index score, and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index of all patients were also recorded and statistically analyzed. Results The ILD frequency in patients with SLE was 11.1%. Compared to the group of SLE patients without ILD, the group of SLE patients with ILD possessed the following statistical differences: elderly age, longer illness duration, lower level of anti-double-stranded deoxyribonucleic acid, and higher level of serum complement 3, increased ratios of Raynaud's phenomenon, moist rales and tachypnea. Multivariate logistic regression results suggested that elderly age (≥60 years), long illness duration (1-10 years, ≥10 years), Raynaud's phenomenon, and tachypnea were statistically associated with the occurrence of ILD in SLE patients. Conclusion Chinese SLE patients who possessed the factors that were statistically associated with ILD, namely, elderly age (≥60 years old), long illness duration (≥1 years), Raynaud's phenomenon, and tachypnea, were recommended to be monitored for the possibility of ILD.
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Affiliation(s)
- Yaling Chen
- Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanqing Wang
- Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiangfang Chen
- Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huishun Liang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xuwei Yang
- Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China
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Kwon KY. Pathological interpretation of connective tissue disease-associated lung diseases. Yeungnam Univ J Med 2019; 36:8-15. [PMID: 31620606 PMCID: PMC6784620 DOI: 10.12701/yujm.2019.00101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 12/17/2022] Open
Abstract
Connective tissue diseases (CTDs) can affect all compartments of the lungs, including airways, alveoli, interstitium, vessels, and pleura. CTD-associated lung diseases (CTD-LDs) may present as diffuse lung disease or as focal lesions, and there is significant heterogeneity between the individual CTDs in their clinical and pathological manifestations. CTD-LDs may presage the clinical diagnosis a primary CTD, or it may develop in the context of an established CTD diagnosis. CTD-LDs reveal acute, chronic or mixed pattern of lung and pleural manifestations. Histopathological findings of diverse morphological changes can be present in CTD-LDs airway lesions (chronic bronchitis/bronchiolitis, follicular bronchiolitis, etc.), interstitial lung diseases (nonspecific interstitial pneumonia/fibrosis, usual interstitial pneumonia, lymphocytic interstitial pneumonia, diffuse alveolar damage, and organizing pneumonia), pleural changes (acute fibrinous or chronic fibrous pleuritis), and vascular changes (vasculitis, capillaritis, pulmonary hemorrhage, etc.). CTD patients can be exposed to various infectious diseases when taking immunosuppressive drugs. Histopathological patterns of CTD-LDs are generally nonspecific, and other diseases that can cause similar lesions in the lungs must be considered before the diagnosis of CTD-LDs. A multidisciplinary team involving pathologists, clinicians, and radiologists can adequately make a proper diagnosis of CTD-LDs.
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Affiliation(s)
- Kun Young Kwon
- Department of Pathology, Dongkang Hospital, Ulsan, Korea
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Jatwani S, Handa R, Jatwani K, Chugh K. Bronchiolitis obliterans organising pneumonia as an initial manifestation in a patient with systemic lupus erythematosus: a rare presentation. BMJ Case Rep 2018; 2018:bcr-2017-224094. [PMID: 29804073 DOI: 10.1136/bcr-2017-224094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bronchiolitis obliterans organising pneumonia as an initial manifestation of systemic lupus erythematosus (SLE) is a rare and uncommon presentation. We describe a case of SLE presenting with shortness of breath, found to have pneumothorax, bilateral nodular infiltrates along with pleural effusions and pericardial effusion. Work-up suggested a diagnosis of active SLE with anaemia, thrombocytopenia, positive antinuclear antibodies (ANAs) and positive anti-double-stranded DNA. On retrospective review of patient records, from 8 years prior to presentation, lung biopsy histology consistent with bronchiolitis obliterans organising pneumonia with positive ANA serology was found, without any further autoimmune work-up. In our opinion, bronchiolitis obliterans organising pneumonia was the index presentation of SLE. Treatment with steroids and subsequent management with immunosuppressive therapy could have prevented subsequent hospitalisations. Prompt work-up for autoimmune diseases should be considered in patients with positive ANA and histological evidence of bronchiolitis obliterans organising pneumonia.
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Affiliation(s)
| | - Richa Handa
- Henry Ford Allegiance Health, Jackson, Michigan, USA
| | - Karan Jatwani
- Mount Sinai Health System, New York City, New York, USA
| | - Karan Chugh
- Wayne State University, Detroit, Michigan, USA
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Kawasumi H, Gono T, Tanaka E, Kaneko H, Kawaguchi Y, Yamanaka H. Clinical Characteristics and Cytokine Profiles of Organizing Pneumonia in Patients with Rheumatoid Arthritis Treated with or without Biologics. J Rheumatol 2016; 43:738-44. [PMID: 26834212 DOI: 10.3899/jrheum.151019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It has been reported that organizing pneumonia (OP) develops when patients with rheumatoid arthritis (RA) are treated with biologic disease-modifying antirheumatic drugs (bDMARD). However, the clinical characteristics and pathophysiology of OP in RA remain unknown in patients treated with bDMARD. We investigated the clinical characteristics and cytokine profiles of patients with RA-OP treated with bDMARD or conventional synthetic DMARD (csDMARD). METHODS Twenty-four patients with RA who had developed OP were enrolled. These patients included 12 treated with bDMARD (bDMARD-OP subset) and 12 treated with csDMARD (csDMARD-OP subset). We compared the clinical characteristics and cytokine profiles between the patients with OP (OP subset, n = 24) and non-OP patients (non-OP subset, n = 29). RESULTS There was no significant difference in clinical characteristics between the OP subset and the non-OP subset. Four patients developed OP within 2 months of bDMARD administration. In the other 8 patients, OP developed more than 1 year after the initiation of bDMARD. OP improved with corticosteroid treatment in all bDMARD-OP patients. After OP improved, bDMARD were readministered in 6 patients, and no OP recurrence was observed in any of these patients. Our multivariate analysis revealed that serum levels of interferon-α (IFN-α), interleukin (IL)-1β, IL-6, IL-8, and interferon-γ-inducible protein 10 were significantly associated with the development of OP, although these cytokines tended to be lower in the bDMARD-OP subset than in the csDMARD-OP subset. CONCLUSION OP is unlikely to be fatal in patients treated with bDMARD or csDMARD. IFN-α and proinflammatory cytokines are associated with the pathophysiology of OP in RA.
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Affiliation(s)
- Hidenaga Kawasumi
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Takahisa Gono
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University.
| | - Eiichi Tanaka
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Hirotaka Kaneko
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Yasushi Kawaguchi
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Hisashi Yamanaka
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
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Rojas CML, Borella E, Palma L, Ragozzino S, De Ramón E, Gomez-Huelgas R, Punzi L, Doria A. Bronchiolitis obliterans organizing pneumonia in patients with autoimmune rheumatic diseases. Immunol Res 2015; 61:97-103. [PMID: 25480740 DOI: 10.1007/s12026-014-8607-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) is defined by buds of granulation tissue within lung distal airspaces. The diagnosis requires the histopathologic evidence of organizing pneumonia along with a suggestive clinical and radiographic pattern. This disorder is characterized by a good response to corticosteroids and an excellent prognosis. It can occur in association with a broad spectrum of clinical conditions or can be isolated, in this last case named cryptogenic organizing pneumonia. We searched for BOOP in patients with autoimmune rheumatic diseases (ARD) in the literature, and we found 32 well-documented cases. We reported here demographic features, manifestations, treatment and outcome of patients with BOOP associated with ARD. Notably, BOOP can be the presenting feature in some patients with ARD; thus, a close follow-up of patients with BOOP is recommended.
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Affiliation(s)
- Carmen Maria Lara Rojas
- Internal Medicine Department, Biomedical Institute of Malaga (IBIMA), University Hospitals, Regional and Clinical Virgen de la Victoria of Malaga, Málaga, Spain
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Abstract
The pathologic correlates of interstitial lung disease (ILD) secondary to connective tissue disease (CTD) comprise a diverse group of histologic patterns. Lung biopsies in patients with CTD-associated ILD tend to demonstrate simultaneous involvement of multiple anatomic compartments of the lung. Certain histologic patterns tend to predominate in each defined CTD, and it is possible in many cases to confirm connective tissue-associated lung disease and guide patient management using surgical lung biopsy. This article will cover the pulmonary pathologies seen in rheumatoid arthritis, systemic sclerosis, myositis, systemic lupus erythematosus, Sjögren syndrome, and mixed CTD.
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Mira-Avendano IC, Abril A. Pulmonary manifestations of Sjögren syndrome, systemic lupus erythematosus, and mixed connective tissue disease. Rheum Dis Clin North Am 2015; 41:263-77. [PMID: 25836642 DOI: 10.1016/j.rdc.2015.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Interstitial lung disease is a common and often life-threatening manifestation of different connective tissue disorders, often affecting its overall prognosis. Systemic lupus erythematosus, Sjögren syndrome, and mixed connective tissue disease, although all unique diseases, can have lung manifestations as an important part of these conditions. This article reviews the different pulmonary manifestations seen in these 3 systemic rheumatologic conditions.
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Affiliation(s)
- Isabel C Mira-Avendano
- Department of Pulmonary Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Andy Abril
- Department of Rheumatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 33224, USA
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13
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Miyagi R, Ideguchi H, Soga T, Sakamoto K, Niino H, Shiina T, Ueda A, Ishigatsubo Y. Interstitial pneumonia as an initial manifestation in a patient with late-onset SLE. Int J Rheum Dis 2014; 17:813-6. [PMID: 24450298 DOI: 10.1111/1756-185x.12282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Rumiko Miyagi
- Department of Rheumatology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
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Schneider F, Gruden J, Tazelaar HD, Leslie KO. Pleuropulmonary pathology in patients with rheumatic disease. Arch Pathol Lab Med 2012; 136:1242-52. [PMID: 23020730 DOI: 10.5858/arpa.2012-0248-sa] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thoracic manifestations of rheumatic disease (RD) are increasingly recognized as a significant cause of morbidity and mortality worldwide. Rheumatologic underpinnings have been identified in a significant proportion of patients with interstitial lung disease. The 5 RDs most frequently associated with pleuropulmonary disease are (1) rheumatoid arthritis, (2) systemic lupus erythematosus, (3) progressive systemic sclerosis, (4) polymyositis/dermatomyositis, and (5) Sjögren syndrome. The onset of thoracic involvement in these diseases is variable. In some patients, it precedes the systemic disease or is its only manifestation. Moreover, there is a wide spectrum of clinical presentation ranging from subclinical abnormalities to acute respiratory failure. Histopathologically, the hallmark features of thoracic involvement by RD are inflammatory, targeting one or more lung compartments. The reactions range from acute to chronic, with remodeling by fibrosis being a common result. Although the inflammatory findings are often nonspecific, certain reactions or anatomic distributions may favor one RD over another, and occasionally, a distinctive histopathology may be present (eg, rheumatoid nodules). Three diagnostic dilemmas are encountered in patients with RD who develop diffuse lung disease: 1) opportunistic infection in the immunocompromised host, 2) drug toxicity related to the medications used to treat the systemic disease, and 3) manifestations of the patient's known systemic disease in lung and pleura. To confidently address the latter, the 5 major RDs are presented here, with their most common pleuropulmonary pathologic manifestations, accompanied by brief clinical and radiologic correlations.
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Affiliation(s)
- Frank Schneider
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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15
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Pleural and pulmonary involvement in systemic lupus erythematosus. Presse Med 2011; 40:e19-29. [DOI: 10.1016/j.lpm.2010.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 11/04/2010] [Accepted: 11/05/2010] [Indexed: 11/18/2022] Open
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Carmier D, Marchand-Adam S, Diot P, Diot E. Respiratory involvement in systemic lupus erythematosus. Rev Mal Respir 2010; 27:e66-78. [DOI: 10.1016/j.rmr.2010.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hariri LP, Unizony S, Stone J, Mino-Kenudson M, Sharma A, Matsubara O, Mark EJ. Acute fibrinous and organizing pneumonia in systemic lupus erythematosus: a case report and review of the literature. Pathol Int 2010; 60:755-9. [PMID: 20946526 DOI: 10.1111/j.1440-1827.2010.02586.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pulmonary manifestations of systemic lupus erythematosus (SLE) typically include pleuritis, alveolar hemorrhage, and infectious pneumonia due to immunosuppression with less common entities including bronchiolitis, interstitial pneumonia, and pulmonary fibrosis. More rare manifestations include organizing pneumonia (OP) and diffuse alveolar damage (DAD). A similar but distinct entity of acute fibrinous and organizing pneumonia (AFOP), characterized by intra-alveolar fibrin deposition and associated organizing pneumonia, has been reported in association with connective tissue disorders, but has not been described in association with SLE. Reported herein is a patient with SLE and accompanying antiphospholipid syndrome with recent pulmonary embolism, persistent respiratory symptomology, and persistent radiographic abnormalities who underwent lung biopsy displaying features of AFOP. This case in conjunction with previous literature indicates that AFOP can be a manifestation of connective tissue disease including SLE and may be an underreported variant of medical lung disease due to overlap in histological characteristics with OP and DAD.
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Affiliation(s)
- Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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18
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Abstract
Collagen vascular disease is one of the most common causes of chronic infiltrative lung disease. Patterns of lung injury from collagen vascular disease include nonspecific interstitial pneumonia (NSIP), usual interstitial pneumonia, organizing pneumonia, bronchiectasis, obliterative bronchiolitis, and pulmonary arterial hypertension. The prevalence of each entity varies according to the specific disease entity. NSIP and pulmonary hypertension are common in scleroderma, whereas usual interstitial pneumonia, bronchiectasis, and obliterative bronchiolitis are commonly found in rheumatoid arthritis. In systemic lupus erythematosus, pleural effusions and pulmonary hemorrhage are the salient features. In polymyositis, a combination of organizing pneumonia and NSIP is characteristic. Sjögren syndrome is characterized by bronchiectasis and lymphoid interstitial pneumonia, often associated with thin-walled cysts. Ankylosing spondylitis is associated with upper lobe fibrosis, and may be complicated by mycetoma.
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Affiliation(s)
- David A Lynch
- Division of Radiology, National Jewish Health, Denver, CO 80206, USA.
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19
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Carmier D, Marchand-Adam S, Diot P, Diot E. Atteinte respiratoire au cours du lupus érythémateux systémique. Rev Mal Respir 2008; 25:1289-303. [DOI: 10.1016/s0761-8425(08)75093-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Swigris JJ, Fischer A, Gillis J, Gilles J, Meehan RT, Brown KK. Pulmonary and thrombotic manifestations of systemic lupus erythematosus. Chest 2008; 133:271-80. [PMID: 18187752 DOI: 10.1378/chest.07-0079] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is considered the archetypal systemic autoimmune disease. Clinically characterized by multisystem involvement and varied serologic abnormalities, no two patients present or have disease that evolves in exactly the same way. Viewed histologically, SLE is characterized by some combination of inflammation and fibrosis, and the clinical phenotype is dictated by the relative contributions of each and the organs affected. Tissue injury appears to be mediated by characteristic autoantibody production, immune complex formation, and their organ-specific deposition. As expected in a multisystem disease, the entire pulmonary system is vulnerable to injury. Any of its compartments-airways, lung parenchyma, vasculature, pleura, or the respiratory musculature-may be independently or simultaneously affected. This article offers the reader a comprehensive review of the numerous pulmonary and thrombotic manifestations of SLE and suggests approaches to their management.
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Affiliation(s)
- Jeffrey J Swigris
- Autoimmune Lung Disease Center, National Jewish Medical and Research Center, Denver, CO 80206, USA.
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21
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Tomashefski JF, Cagle PT, Farver CF, Fraire AE. Collagen Vascular Diseases and Disorders of Connective Tissue. DAIL AND HAMMAR’S PULMONARY PATHOLOGY 2008. [PMCID: PMC7120184 DOI: 10.1007/978-0-387-68792-6_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The collagen vascular diseases, also referred to as connective tissue diseases, are a diverse group of systemic inflammatory disorders thought to be immunologically mediated. The concept of collagen vascular disease began to take shape in the 1930s, when it was recognized that rheumatic fever and rheumatoid arthritis can affect connective tissues throughout the body.1,2 During the following decade, as conditions such as systemic lupus erythematosus (SLE) and scleroderma came to be viewed as systemic diseases of connective tissue, the terms diffuse connective disease and diffuse collagen disease were proposed.3,4 During the same period, the designation of diffuse vascular disease was proposed for diseases such as scleroderma, polymyositis, SLE, and polyarteritis nodosa, which featured widespread vascular involvement.5 With the realization that many of these entities can exhibit both systemic connective tissue manifestations and vascular abnormalities, the unifying designation of collagen vascular disease was introduced.6
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Affiliation(s)
- Joseph F. Tomashefski
- grid.67105.350000000121643847Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH USA ,grid.411931.f0000000100354528Department of Pathology, MetroHealth Medical Center, Cleveland, OH USA
| | - Philip T. Cagle
- grid.5386.8000000041936877XDepartment of Pathology, Weill Medical College of Cornell University, New York, NY ,grid.63368.380000000404450041Pulmonary Pathology, Department of Pathology, The Methodist Hospital, Houston, TX USA
| | - Carol F. Farver
- grid.239578.20000000106754725Pulmonary Pathology, Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, OH USA
| | - Armando E. Fraire
- grid.168645.80000000107420364Department of Pathology, University of Massachusetts Medical School, Worcester, MA USA
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22
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Schmidt GA, Hunninghake GW. Immunologic Lung Disease in the Critically Ill. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Carvalho L, Freitas S. [Vasculitis and diffuse panbronchiolitis-like in systemic lupus erythematosus--case report]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2007; 13:267-74. [PMID: 17492236 DOI: 10.1016/s0873-2159(15)30347-0] [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: 11/24/2022] Open
Abstract
Visceral involvement in systemic lupus erythematosus (SLE) extends beyond renal and cutaneous management. Pleuro-pulmonary lesions have been recognised and diffuse alveolar damage and hemorrhage are the most difficult patterns to control. Pulmonary compromise in clinical evolution of SLE differs from children to adults, both in morphological patterns and in clinical presentation, depending on immunocompetence and the treatment prescribed. A 16-year-old boy presented asthenia, malaise and bilateral cervical painless adenopathies understood as EBV infection as serological EBV IgG, IgM and EBNA were positive. The symptoms persisted for eight months when discrete erythematous and desquamative nasal and malar rash expressed together with persistent fever, dispnoea and bibasilar crackles. Lymph node and pulmonary biopsies were performed. Lymph node presented follicular hyperplasia and LMP1 (EBV) immunostaining was negative. In lung biopsy bronchovascular lesions were consistent with vasculitis and bronchiolitis due to intense macrophage infiltration, validated with CD68 antibody and intra-alveolar macrophages were also present with septal compromise; LMP1 (EBV) positive cells were not visualized. The lung pattern seen in CAT as diffuse micronodules all over the lung parenchyme resolved after corticosteroid therapy. The diagnosis of SLE was confirmed by ANA, anti-dsDNA, anti-nDNA and anti-histones positivity. To the best of our knowledge this is the first reported case of pulmonary SLE involvement with vasculitis and diffuse panbronchiolitis - like pattern as the first clinical sign of the disease.
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25
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Bin J, Bernatsky S, Gordon C, Boivin JF, Ginzler E, Gladman D, Fortin PR, Urowitz M, Manzi S, Isenberg D, Rahman A, Petri M, Nived O, Sturfeldt G, Ramsey-Goldman R, Clarke AE. Lung cancer in systemic lupus erythematosus. Lung Cancer 2007; 56:303-6. [PMID: 17291624 DOI: 10.1016/j.lungcan.2007.01.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 01/10/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evidence points to a link between systemic lupus erythematosus (SLE) and an increased risk of lung cancer. Our objective was to provide a brief report of the lung cancer cases from an SLE cohort, with respect to demographics, histology, and exposures to smoking and immunosuppressive medications. METHODS Data were obtained from a multi-site international cohort study of over 9500 SLE patients from 23 centres. Cancer cases were ascertained through linkage with regional tumor registries. RESULTS We analyzed information on histology subtype for 30 lung cancer cases that had occurred across five countries. Most (75%) of these 30 cases were female, with a median age of 61 (range 27-91) years. In eight cases, the histological type was not specified. In the remainder, the most common histological type reported was adenocarcinoma (N=8; two of the adenocarcinomas were bronchoalveolar carcinoma) followed by small cell carcinoma (N=6), and squamous cell carcinoma (N=6) with one case each of large cell carcinoma and carcinoid tumor. Most (71%) of the lung cancer cases were smokers; only the minority (20%) had been previously exposed to immunosuppressive agents. CONCLUSIONS The histological distribution of the lung cancers from the SLE sample appeared similar to that of lung cancer patients in the general population, though the possibility of a higher proportion of more uncommon tumors (such as bronchoalveolar and carcinoid) cannot be excluded. A large proportion of the cancer cases were smokers, which is also not surprising. However, only a minority appeared to have been exposed to immunosuppressive agents. A large case-cohort study currently in progress should help shed light on the relative importance of these exposures in lung cancer risk for SLE patients.
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Affiliation(s)
- J Bin
- McGill University Health Center (MUHC), Department of Medicine, Montreal, QC, Canada, and University Hospital, Lund, Sweden
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Bravo Soberón A, Torres Sánchez MI, García Río F, Sánchez Almaraz C, Parrón Pajares M, Pardo Rodríguez M. [High-resolution computed tomography patterns of organizing pneumonia]. Arch Bronconeumol 2007; 42:413-6. [PMID: 16948996 DOI: 10.1016/s1579-2129(06)60557-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Organizing pneumonia is an uncommon lung disease with a wide variety of radiologic findings, few of which have been discussed in the literature. We performed high resolution computed tomography on 34 patients with a histological diagnosis of organizing pneumonia and studied the images they presented. Twenty-five of the cases were idiopathic and 9 secondary. The findings observed were parenchymal consolidation (76%), ground glass opacity (59%), bronchial dilatation (53%), centrilobular nodules (35%), septal thickening (23%), halo sign (15%), and reversed halo sign (12%). Secondary cases presented more findings of septal thickening and fewer complete remissions.
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27
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Bravo Soberón A, Torres Sánchez MI, García Río F, Sánchez Almaraz C, Parrón Pajares M, Pardo Rodríguez M. Patrones de presentación de la neumonía organizada mediante tomografía computarizada de alta resolución. Arch Bronconeumol 2006. [DOI: 10.1157/13091652] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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28
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Takada H, Saito Y, Nomura A, Ohga S, Kuwano K, Nakashima N, Aishima S, Tsuru N, Hara T. Bronchiolitis obliterans organizing pneumonia as an initial manifestation in systemic lupus erythematosus. Pediatr Pulmonol 2005; 40:257-60. [PMID: 15880402 DOI: 10.1002/ppul.20224] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare complication of adult systemic lupus erythematosus (SLE). This is the first report of a pediatric patient with BOOP as an initial presentation of SLE. She had dyspnea, cough, arthralgia, and erythema on her face. Laboratory examinations revealed pancytopenia, low serum levels of complements, and positivity for anti-nuclear antibody, anti-double stranded DNA antibody, and anti-SM antibody. Her respiratory symptoms, pulmonary function tests, and radiologic findings showed significant improvement after treatment with oral prednisolone. Although it is a rare complication among the pleuro-pulmonary manifestations in SLE, BOOP can be the first presentation, even in pediatric patients.
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Affiliation(s)
- Hidetoshi Takada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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29
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Abstract
The connective tissue disorders (also called collagen vascular diseases) represent an heterogeneous group of immunologically mediated inflammatory disorders with a large variety of affected organs besides the lungs. The respiratory system may be involved in all its components: airways, vessels, parenchyma, pleura, respiratory muscles, etc. The frequency, clinical presentation, prognosis and response to therapy vary, depending on the pattern of involvement as well as on the underlying connective tissue disorders. The subject of this review is to describe the most frequent type of lung disorders observed in patients with connective tissue disease (CTD). We will focus on the most frequent CTD: systemic lupus erythematosus, rheumatoid arthritis, scleroderma, Sjogren's syndrome, dermatopolymyositis and mixed CTD.
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Affiliation(s)
- B Crestani
- Service de Pneumologie, Hôpital Bichat-Claude Bernard, Paris Cedex, France
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30
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Abstract
This article reviews the current use of the wide variety of imaging modalities now available, presenting the imaging features of common and important causes of acute and chronic rheumatic disorders including juvenile idiopathic arthritis, spondyloarthropathies/enthesitis-related arthritis, sepsis, autoimmune diseases, vasculitis, and osteoporosis.
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Affiliation(s)
- Paul Babyn
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada.
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31
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Abstract
A large and diverse group of pathologic conditions manifests clinically and radiologically as diffuse parenchymal lung disease. Diffuse interstitial lung diseases (ILDs) encompass mainly inflammatory processes that involve the structural elements of this organ. Some ILDs are caused by infections, but most are the result of immunologic, environmental, or toxic mechanisms. Currently, less morbid sampling techniques have increased dramatically the probability that pulmonologists will be faced with establishing a specific and clinically relevant diagnosis using surgical lung biopsy material. Most of the concepts presented in this article have been established using this type of specimen. In the early years of surgical lung biopsy, a small number of diffuse inflammatory conditions came to light that exclusively involved the lungs and did not seem to be caused by infection, toxin, sarcoidosis, pneumoconiosis, or neoplasm. In this article, these idiopathic disorders are discussed in the context of their dominant pathologic findings rather than presented as a separate group of entities.
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Affiliation(s)
- Kevin O Leslie
- Department of Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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32
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Freudenberger TD, Madtes DK, Curtis JR, Cummings P, Storer BE, Hackman RC. Association between acute and chronic graft-versus-host disease and bronchiolitis obliterans organizing pneumonia in recipients of hematopoietic stem cell transplants. Blood 2003; 102:3822-8. [PMID: 12869516 DOI: 10.1182/blood-2002-06-1813] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) has been reported following hematopoietic stem cell (HSC) transplantation, but the clinical features and risk factors for this disorder have not been well characterized. This case-control study of 49 patients with histologic BOOP and 161 control subjects matched by age and year of transplantation describes the clinical features and analyzes the risk factors for BOOP following HSC transplantation. Data on clinical features and outcome were collected by chart review. Odds ratios, estimating the relative risk of BOOP in allogeneic HSC recipients, were calculated by conditional logistic regression with adjustment for potential confounding factors. Clinical features of BOOP in this population were similar to idiopathic BOOP and BOOP occurring in other disease settings. There was an association between acute and chronic graft-versus-host disease (GVHD) and the subsequent development of BOOP (odds ratios, 3.8 [95% CI, 1.2 to 12.3] and 3.1 [95% CI, 1.1 to 9.2], respectively). Patients with BOOP were more likely to have acute GVHD involving the skin (odds ratio, 4.6; P =.005) and chronic GVHD involving the gut (odds ratio, 6.6; P =.018) and oral cavity (odds ratio, 5.9; P =.026). This study shows that histologic BOOP following HSC transplantation has clinical features that resemble idiopathic BOOP and is strongly associated with prior acute and chronic GVHD. These results have important implications for the care of patients who develop respiratory symptoms after HSC transplantation and may help elucidate the pathogenesis of idiopathic BOOP.
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Affiliation(s)
- Todd D Freudenberger
- Department of Medicine, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
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33
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34
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Alhamad EH, Lynch JP, Martinez FJ. Pulmonary function tests in interstitial lung disease: what role do they have? Clin Chest Med 2001; 22:715-50, ix. [PMID: 11787661 DOI: 10.1016/s0272-5231(05)70062-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pulmonary function tests have been widely accepted and utilized in the management of interstitial lung diseases. Although the tests performed have changed little over the past several decades, extensive literature has been published highlighting their clinical role in the diagnosis, staging, prognostication, and follow-up of patients with a wide variety of interstitial lung diseases.
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Affiliation(s)
- E H Alhamad
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, USA
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35
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Affiliation(s)
- J F Cordier
- Service de Pneumologie, Hôpital Louis Pradel, Université Claude Bernard, 69394 Lyon Cedex, France
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36
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Abstract
This review article describes the imaging finding of the connective tissue disorders in children. The radiological features of the following conditions are described; the spondyloarthropathics, systemic lupus erythematosus (SLE), dermatomyositis, scleroderma, the vasculitides, Kawasaki disease, synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO), and focal myositis. The features on several integrated imaging techniques are described.
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Affiliation(s)
- R Hanlon
- Royal Liverpool Children's NHS Trust, UK
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37
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Affiliation(s)
- M P Keane
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
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38
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Calvo de Mora Álvarez J, Arias Martínez N, Barbado Hernández F, Linares P, Pérez Martín G, Casal V, Vázquez J. Bronquiolitis obliterante con neumonía organizada asociada a vasculitis cutánea. Rev Clin Esp 2000. [DOI: 10.1016/s0014-2565(00)70597-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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39
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Kim JS, Lee KS, Koh EM, Kim SY, Chung MP, Han J. Thoracic involvement of systemic lupus erythematosus: clinical, pathologic, and radiologic findings. J Comput Assist Tomogr 2000; 24:9-18. [PMID: 10667651 DOI: 10.1097/00004728-200001000-00003] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Thoracic involvement occurs more frequently in systemic lupus erythematosus than in any other connective tissue diseases, and more than half of patients with the disease suffer from the involvement. Primary intrathoracic manifestations include pleural disease (effusions and/or thickening), acute lupus pneumonitis, subacute interstitial lung disease including bronchiolitis obliterans organizing pneumonia and non-specific interstitial pneumonia with fibrosis, chronic interstitial lung disease of usual interstitial pneumonia, pulmonary hemorrhage, pulmonary vascular disease, small airway disease of bronchiolitis obliterans, and pulmonary arterial hypertension. Secondary intrathoracic manifestations include atelectasis due to diaphragmatic dysfunction, opportunistic pneumonia, drug and oxygen toxicity, aspiration, and pleuropulmonary consequences of cardiac and renal failure.
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Affiliation(s)
- J S Kim
- Department of Radiology, Pochon CHA University, Pundang CHA General Hospital, Kyonggi-Do, Korea
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40
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects young women. The respiratory system is more commonly involved in SLE than in any other collagen vascular disease. SLE may affect virtually all components of the respiratory system, including the upper airway, lung parenchyma, pulmonary vasculature, pleura, and respiratory muscles. Respiratory system involvement ranges from symptomatic to fulminant and life threatening. This article reviews the pulmonary manifestations of SLE, including drug-induced SLE.
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Affiliation(s)
- S Murin
- Department of Internal Medicine, University of California, Davis School of Medicine, USA
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41
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Ooi GC, Ngan H, Peh WC, Mok MY, Ip M. Systemic lupus erythematosus patients with respiratory symptoms: the value of HRCT. Clin Radiol 1997; 52:775-81. [PMID: 9366539 DOI: 10.1016/s0009-9260(97)80159-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ten Chinese patients with systemic lupus erythematosus (SLE) and with persistent respiratory symptoms were evaluated with high resolution computed tomography (HRCT), chest radiographs and lung function tests. Fourteen of 15 HRCT scans performed were abnormal. The predominant disease pattern, seen in 60% of patients, was one of chronic interstitial lung disease with honeycombing, architectural distortion, parenchymal bands, pleural irregularity, and a lower zone predominance. Three of 10 patients had histological evidence of either lung fibrosis or interstitial pneumonitis. Airways disease and pleural thickening were seen in 20% and 87% of scans, respectively. Pleural thickening and honeycombing were present in 53% and 20% of chest radiographs, respectively. All concurrent lung function tests were abnormal. Reduced diffusion capacity of carbon monoxide (DLCO/VA) was observed in 60% of lung function tests. There was no correlation between duration of disease and DLCO/VA. However, pathological reduction of DLCO/VA was seen in 71% of patients with honeycombing, and 88% of patients with ground glass opacity. Our study has documented a high incidence of HRCT features of chronic lung destruction and a lower zone predominance in SLE patients with persistent respiratory symptoms.
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Affiliation(s)
- G C Ooi
- Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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42
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El-Reshaid K, Madda JP, Chugh TD. Bronchiolitis obliterans organizing pneumonia associated with systemic lupus erythematosus. Ann Saudi Med 1996; 16:332-4. [PMID: 17372479 DOI: 10.5144/0256-4947.1996.332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- K El-Reshaid
- Departments of Medicine and Microbiology, Kuwait University and Department of Pathology, Ameri Hospital, Ministry of Health, Kuwait
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43
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Costabel U, Guzman J, Teschler H. Bronchiolitis obliterans with organising pneumonia: outcome. Thorax 1995; 50 Suppl 1:S59-64. [PMID: 7570467 PMCID: PMC1129018 DOI: 10.1136/thx.50.suppl_1.s59] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- U Costabel
- Abteilung Pneumologie/Allergologie, Ruhrlandklinik, Essen, Germany
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44
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Alasaly K, Muller N, Ostrow DN, Champion P, FitzGerald JM. Cryptogenic organizing pneumonia. A report of 25 cases and a review of the literature. Medicine (Baltimore) 1995; 74:201-11. [PMID: 7623655 DOI: 10.1097/00005792-199507000-00004] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cryptogenic organizing pneumonia (COP), also known as bronchiolitis obliterans organizing pneumonia (BOOP), is an uncommon lung disease characterized by the presence of granulation tissue within the alveolar ducts and alveoli. Because of the limited published literature on this topic and limited information on outcome we reviewed our own experience over an 8-year period and also critically evaluated the literature. We reviewed all cases of COP diagnosed from 1985 through 1992 at Vancouver General Hospital: 25 patients (14 male, 11 female) aged 20-77 years (mean, 49 yr, SD +/- 17 yr). Nine patients had myeloproliferative disorder, including 6 who had allogenic bone marrow transplants; 2 patients had connective tissue disease; and 14 patients had no underlying disease (idiopathic). Data retrieved retrospectively from clinical records included demographics, risk factors, symptoms, chest radiographs, computerized tomograms, lung function tests, therapy prescribed, and response to therapy. Symptoms included dyspnea and cough (n = 15) (60%), cough only (n = 10) (40%), and fever (n = 15) (60%). Twenty-two patients were diagnosed by open lung biopsy and 3 by transbronchial biopsy. Lung imaging showed bilateral patchy airspace consolidation or nodular opacities as the main finding in 22 patients. Pulmonary function tests showed a combined restrictive and obstructive pattern. All patients received prednisone therapy except 1 patient whose idiopathic findings resolved completely with minimal treatment. Eight patients died, including 4 of the 9 patients with myeloproliferative disorder--2 from a combination of respiratory failure due to COP and graft-versus-host disease. One of 2 patients with connective tissue disease died, and 3 of 14 patients with idiopathic COP died. COP is an uncommon condition but should be considered in patients with bilateral airspace disease, especially those who fail to respond to antibiotics for presumed pneumonia. Although pulmonary function tests and CT scan findings in conjunction with the clinical features usually suggest the diagnosis, definite confirmation usually requires either open lung biopsy or transbronchial biopsy. Histologic confirmation of the diagnosis is particularly warranted as therapy with corticosteroids is usually needed for a number of months. The prognosis is excellent with idiopathic cases but more guarded especially when COP is associated with lymphoproliferative or connective tissue disease.
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Affiliation(s)
- K Alasaly
- Department of Respiratory Medicine, Vancouver General Hospital, Canada
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45
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García Río F, García Satué JL, Prados C, Casadevall J, Gómez L, Pino JM. [3 nonidiopathic forms of bronchiolitis obliterans organizing pneumonia]. Arch Bronconeumol 1994; 30:263-5. [PMID: 8025803 DOI: 10.1016/s0300-2896(15)31077-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Bronchiolitis obliterans organizing pneumonia is the most serious disease of the bronchioli. An idiopathic form of the disease important for differential diagnosis in incipient forms of pulmonary fibrosis has been reported in the literature, along with other forms associated to drug use, infections, and collagen and localized diseases. We describe 3 patients with bronchiolitis obliterans organizing pneumonia, one associated with rheumatoid arthritis and consumption of gold salts, one with HIV infection and one localized form associated with pulmonary hydatidosis.
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Affiliation(s)
- F García Río
- Servicio de Neumología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid
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Orens JB, Martinez FJ, Lynch JP. PLEUROPULMONARY MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS. Rheum Dis Clin North Am 1994. [DOI: 10.1016/s0889-857x(21)00230-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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