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Loftis CE, Dulgheru E, Kaplan A. Rituximab for steroid-resistant organising pneumonia in a woman with rheumatoid arthritis. BMJ Case Rep 2022; 15:15/11/e249912. [PMID: 36319035 PMCID: PMC9628664 DOI: 10.1136/bcr-2022-249912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Organising pneumonia (OP) is a form of interstitial pneumonia characterised by inflammation and scarring leading to obstruction within the small airways and alveoli. Practice guidelines recommend treatment of moderate to severe OP with glucocorticoids; however, there have been cases of steroid-resistant OP successfully treated with rituximab. We describe a case of a woman in her 20s with rheumatoid arthritis who presented with pleuritic chest pain, haemoptysis and dyspnoea on exertion and was diagnosed with OP after multiple radiographic images and biopsies. The patient failed numerous treatment regimens, including corticosteroids, antibiotics and mycophenolate, but was successfully treated with rituximab. This case highlights the importance of identifying new therapeutic agents that will minimise the use of glucocorticoids in the treatment of OP.
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Affiliation(s)
| | - Emilia Dulgheru
- Rheumatology Institute at Doctors Hospital at Renaissance, Edinburg, Texas, USA
| | - Adolfo Kaplan
- Pulmonary and Sleep Center of the Valley, McAllen, Texas, USA
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Khanna S, Talwar D, Kumar S, Acharya S, Hulkoti V. Scrub typhus presenting as cryptogenic organizing pneumonia in a young female: A first case report. J Family Med Prim Care 2022; 11:5667-5669. [PMID: 36505619 PMCID: PMC9731062 DOI: 10.4103/jfmpc.jfmpc_2059_21] [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: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/24/2021] [Indexed: 12/15/2022] Open
Abstract
We report the case of a young female suffering from fever and generalized weakness on presentation and was diagnosed to be a case of cryptogenic organizing pneumonia (COP). She developed breathlessness on rest and required oxygen support and on further evaluation diagnosed with Scrub typhus IgM positive status. This case report highlights the importance of a rare presentation of Scrub typhus in a young female presenting with clinically silent chest changes initially and preventable worse outcomes if detected and managed for scrub typhus infection early in the course of disease.
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Affiliation(s)
- Shivam Khanna
- Department of Medicine, Jawaharlal Nehru Medical College, DattaMegheInstitute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Dhruv Talwar
- Department of Medicine, Jawaharlal Nehru Medical College, DattaMegheInstitute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India,Address for correspondence: Dr. Dhruv Talwar, Department of Medicine, Jawahar Lal Nehru Medical College, DattaMegheInstitute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India. E-mail:
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, DattaMegheInstitute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, DattaMegheInstitute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Vidyashree Hulkoti
- Department of Medicine, Jawaharlal Nehru Medical College, DattaMegheInstitute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
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Faisal M, Roslan A, Nik Abeed NN, Ban Yu-Lin A. Disease-modifying antirheumatic drugs and organising pneumonia. BMJ Case Rep 2021; 14:14/1/e238173. [PMID: 33408105 PMCID: PMC7789045 DOI: 10.1136/bcr-2020-238173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Organising pneumonia (OP) in rheumatoid arthritis (RA) may be part of pulmonary manifestation (disease related) or disease-modifying antirheumatic drugs (DMARDs) related. We report a case series of RA patients with DMARDs related OP. A 65-year-old woman developed OP 3 weeks after initiation of methotrexate (MTX). High-resolution CT (HRCT) scan of the thorax revealed bilateral consolidations in the lung bases. She had complete radiological resolution 6 months after corticosteroid therapy with cessation of MTX. The second case was of a 60-year-old woman on MTX with recent addition of leflunomide due to flare of RA. She developed worsening cough 4 months later and HRCT scan revealed consolidation in the left upper lobe with biopsy proven OP. She responded within 6 months of corticosteroid therapy with clinical and radiological resolution. This case series highlights that OP may developed with low-dose MTX (as early as 3 weeks) and leflunomide and the diagnosis requires a high index of suspicion.
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Affiliation(s)
- Mohamed Faisal
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Asyraf Roslan
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Nik Nuratiqah Nik Abeed
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Andrea Ban Yu-Lin
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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Gouveia PA, Ferreira ECG, Cavalcante Neto PM. Organizing Pneumonia Induced by Tocilizumab in a Patient with Rheumatoid Arthritis. Cureus 2020; 12:e6982. [PMID: 32201660 PMCID: PMC7075508 DOI: 10.7759/cureus.6982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Interstitial lung disease is a significant extra-articular manifestation of rheumatoid arthritis, due to its prevalence, morbidity and mortality. Biological therapies are widely used for rheumatoid arthritis treatment. However, some biological agents have been related to the induction or exacerbation of interstitial lung disease. We report a 51-year-old woman with knee arthralgia, hand and foot joint deformities. Although there were no respiratory symptoms, rheumatoid arthritis and interstitial lung disease were diagnosed. High-resolution computed tomography (HRCT) detected a radiological pattern of nonspecific interstitial pneumonia. After tocilizumab therapy for nine months, a second HRCT detected a worsening of interstitial lung disease, presenting a pattern of organizing pneumonia. Tocilizumab was discontinued and prednisone (1 mg/kg/day) was introduced. After two months, a further HRCT detected a significant improvement in organizing pneumonia. There are few similar cases in the literature of tocilizumab-induced organizing pneumonia in patients with rheumatoid arthritis. Despite being a rare adverse effect, knowledge of this association is important for monitoring the use of tocilizumab.
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Affiliation(s)
- Pedro A Gouveia
- Internal Medicine, Hospital Das Clinicas, Federal University of Pernambuco, Recife, BRA
| | | | - Paulo M Cavalcante Neto
- Internal Medicine: Pulmonology, Institute of Medical Assistance to the State Public Servant, São Paulo, BRA
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Ohe M, Shida H, Horita T, Ito K, Sugiura M, Hattori A, Oku K. Successful treatment of three patients with organizing pneumonia associated with rheumatoid arthritis using clarithromycin and prednisolone. Drug Discov Ther 2019; 11:218-222. [PMID: 28867755 DOI: 10.5582/ddt.2017.01043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Macrolides have anti-inflammatory effects and have been used to treat diffuse panbronchiolitis, bronchiectasis, and cystic fibrosis. Lately, several cases of cryptogenic organizing pneumonia (COP) and radiotherapy-related organizing pneumonia (OP) that were successfully treated with macrolides considering their anti-inflammatory effects were reported. We report three cases of OP associated with rheumatoid arthritis (RA) successfully treated with clarithromycin (CAM) and prednisolone (PSL). Case 1: A 70-year-old woman suffering from RA was admitted with cough and severe dyspnea. She was diagnosed with OP associated with RA on the basis of computed tomography (CT) findings and transbronchial lung biopsy results. She was successfully treated with PSL and cyclosporine A. At the exacerbation of OP, she was successfully treated with CAM and PSL. Case 2: A 74-year-old man suffering from COP visited our department with arthralgia and articular swellings. He was diagnosed with RA, which was thought to be associated with OP. He was successfully treated with CAM and PSL. Case 3: A 54-year-old man suffering from RA presented with an exacerbation of arthralgia and articular swellings and cough. He was diagnosed with OP associated with RA on the basis of CT findings. He was successfully treated with CAM and PSL. The present cases suggest that CAM and PSL treatment may be effective in some cases of OP associated with RA.
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Affiliation(s)
- Masashi Ohe
- Department of Internal Medicine, JCHO Hokkaido Hospital
| | - Haruki Shida
- Department of Internal Medicine, JCHO Hokkaido Hospital
| | | | - Kenichiro Ito
- Department of Respiratory Medicine, JCHO Hokkaido Hospital
| | | | | | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine
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Yu G, Ji H, Meng C, Huang Y, Gao G, Liu C, Wang S, Zhang L, Ju J. Surgical management of organizing pneumonia: a retrospective study of 24 cases in a single Centre. J Cardiothorac Surg 2019; 14:122. [PMID: 31253173 PMCID: PMC6599375 DOI: 10.1186/s13019-019-0939-2] [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: 04/13/2019] [Accepted: 06/17/2019] [Indexed: 11/29/2022] Open
Abstract
Background Organizing pneumonia (OP) is a rare disease that is often easily misdiagnosed as a malignancy. The diagnosis of OP can prove quite challenging. Patients typically receive treatment with high-dose corticosteroids. Relapse is common if corticosteroid treatment is reduced or stopped. However, given that long-term corticosteroid treatment often results in significant side-effects, the aim of this study was to discuss the diagnosis and surgical treatment of OP. Material and methods The medical records of 24 patients with pathologically diagnosed OP between October 2007 and January 2019 were retrospectively reviewed. All patients underwent thoracic computed tomography (CT) and transbronchial biopsy or CT-guided percutaneous needle aspiration. We analysed the clinical manifestations, radiological findings, diagnostic methods, treatment, and follow-up outcomes of all patients. Results In total, 24 patients with OP were identified. The study included 17 (70.8%) men and 7 (29.2%) women, and the mean age was 61.25 ± 11.33 years (range: 31–82). The most common symptom was cough (n = 16; 66.6%), and the most common radiological finding was consolidation (n = 13; 54.2%) on thoracic CT. The diagnosis of OP was made by transbronchial biopsy in 11 patients (45.8%), and percutaneous needle aspiration biopsy in 13 (54.2%). We performed 11 wedge resections, 9 segmentectomy, and 4 lobectomies. Twenty patients underwent video-assisted thoracoscopic surgery (VATS), and 4 underwent thoracotomy. Complete lesion resection was obtained in all patients, and all patients were discharged from the hospital between 5 and 11 days after surgery. The mean follow-up period was 59.1 ± 34.5 (range: 2–134) months. Residual lesions or local or distant recurrence were not observed. Conclusions OP is a rare disease, and the exact aetiology remains unclear. Preoperative diagnosis is difficult to achieve despite the use of transbronchial biopsy or CT-guided percutaneous needle aspiration. Complete surgical resection represents an effective method for the treatment of OP.
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Affiliation(s)
- Ge Yu
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Huaijun Ji
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China.
| | - Chuizheng Meng
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Yixuan Huang
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Guogang Gao
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Chuanping Liu
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Shanlei Wang
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Lei Zhang
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Jin Ju
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China.
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Mori S, Furukawa H, Kawaguchi Y, Suda T, Tasaka S. Current Developments in Interstitial Lung Disease. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2016; 9:173-7. [PMID: 27656093 PMCID: PMC5015700 DOI: 10.4137/ccrpm.s40867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Hiroshi Furukawa
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sadatomo Tasaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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