Bronchiolitis obliterans organizing pneumonia following a jalapeño grease fire

Systematic Review of Systemic Corticosteroids for Treatment of Organizing Pneumonia

Introduction

Regardless corticosteroids are recommended for the treatment of organizing pneumonia there is limited evidence supporting this practice. Thus, we performed a systematic review of the literature on systemic corticosteroid treatment for organizing pneumonia.

Methods

A search was implemented in the PubMed database (Medline) for articles published in the last 20 years. Those studies with incomplete or insufficient data and case reports were excluded. We collected data including: demographics, clinical data, diagnostic procedures, aetiology, treatment regimen (drug, posology, duration, response) and evolution.

Results

A total of 135 publications were selected and finally 13 studies with 849 patients were included in the review: 12 retrospective observational studies and a single prospective observational study. Most of the patients were started on treatment with systemic corticosteroids - a total of 627 (30-100% depending on the series), but there was a great heterogeneity regarding drug, doses and duration. On those that started treatment, 226 (36%) presented a relapse of the disease during follow-up. Only one study provided information regarding treatment side-effects.

Conclusion

The findings of this systematic review show the low quality data supporting the use of corticosteroids for the treatment of organizing pneumonia. This highlights a need to undertake appropriately designed studies to investigate which is the most appropriate treatment regimen that trades off benefits and risks of prolonged corticosteroid administration.

Acute Respiratory Distress Syndrome Caused by Occupational Exposure to Waterproofing Spray: A Case Report and Literature Review

Background

Acute respiratory distress syndrome (ARDS) is a serious respiratory disease, caused by severe infection, trauma, shock, inhalation of harmful gases and poisons and presented with acute-onset and high mortality. Timely and accurate identification will be helpful to the treatment and prognosis of ARDS cases. Herein, we report a case of ARDS caused by occupational exposure to waterproofing spray. To our knowledge, inhalation of waterproofing spray is an uncommon cause of ARDS, and what makes our case special is that we ruled out concurrent infections with some pathogens by using metagenomic next-generation sequencing (mNGS) as an auxiliary diagnosis, which presents the most comprehensive etiological examination of similar reports.

Case Presentation

A previously healthy 25 years old delivery man developed hyperpyrexia, chest tightness, cough and expectoration. The symptoms occurred and gradually exacerbated after exposure to a waterproofing spray. The chest computed tomography (CT) finding showed diffuse ground glass and infiltrative shadows in both lungs. The diagnosis of ARDS related to waterproofing spray was established on the basis of comprehensive differential diagnosis and etiological examination. The patient achieved good curative effect after proper systemic glucocorticoid therapy.

Conclusions

The diagnosis and differential diagnosis of acute respiratory failure for outdoor workers, such as delivery drivers or hikers, should be considered whether toxic aerosol exposure exists from daily contacts. The case can educate the public that more attention should be paid to avoid exposure to these chemicals by aerosols/ingestion mode and some preventive strategies should be taken in occupational environment. The treatment effect of glucocorticoids is significant in ARDS patients with general chemical damage caused by inhaling toxic gases and substances.

Analysis of the clinical characteristics of 176 patients with pathologically confirmed cryptogenic organizing pneumonia

Background

Cryptogenic organizing pneumonia (COP), is a form of idiopathic interstitial pneumonia (IIP) and is diagnosed by clinical-radiologic-pathologic (CRP) diagnosis. To summarize the clinical, imaging, pathological, and prognostic characteristics of 176 patients with confirmed COP.

Methods

Patients who were diagnosed with organizing pneumonia (OP) by lung biopsy between January 1, 2000, and December 31, 2013, in our hospital were retrospectively analyzed and followed up until 12/31/2017. COP was confirmed by CRP diagnosis.

Results

A total of 1,346 OP cases were identified including 1,170 (86.9%) secondary OP cases (31 cases were originally misdiagnosed as COP but later confirmed as secondary OP during follow-up) and 176 (13.1%) cases of COP. The 176 patients with COP presented with no specific clinical symptoms and chest CT revealed diverse imaging features, such as patchy ground-glass opacity (112/176, 63.6%), consolidation (100/176, 56.8%), nodules (70/176, 39.8%), and fibrous stripes (69/176, 39.2%). The majority of patients (65.3%, 115/176) presented mixed patterns, and 12 (6.8%) showed a reversed halo sign. Of the 176 patients, 83 patients had unilateral lesions (ULs) and did not undergo glucocorticoid therapy. Of the 93 patients with bilateral lesions (BLs), 3 underwent complete resection and were radically cured. The other 90 patients underwent partial resection; of these patients, 37 cases achieved spontaneous remission, and 53 were treated with glucocorticoid therapy. After steroid therapy was reduced or stopped, 35 (66%) patients experienced recurrence. Overall, the 5-year survival rate for the COP patients in our study was 98.3%.

Conclusions

Our study showed that the majority of the patients pathologically diagnosed as OP had secondary OP (86.9%), with COP accounting for only 13.9% of cases. CRP diagnosis and continuous follow-up may be the key for the accurate diagnosis of COP.