Acute exacerbation of interstitial lung disease in the intensive care unit: Principles of diagnostic evaluation and management

Successful Management of Rapidly Progressive Interstitial Pneumonia With Autoimmune Features in an Elderly Patient: A Case Report

An 82-year-old man presented with acute respiratory distress, a one-week history of dry cough, and worsening dyspnea. Chest computed tomography revealed bilateral diffuse ground-glass opacities, raising suspicion of rapidly progressive interstitial pneumonia. Rapid autoantibody testing confirmed interstitial pneumonia with autoimmune features (IPAF), likely triggered by an upper respiratory infection. Initial treatment with high-dose steroid pulse therapy was insufficient to stabilize the patient's respiratory status. Cyclophosphamide pulse therapy was initiated on day 4, resulting in significant improvement by day 7. The patient's oxygen requirements steadily decreased, and follow-up imaging showed near-complete resolution of lung abnormalities. Intensive immunosuppressive therapy, infection control measures, and tailored supportive care enabled functional recovery and discharge to a rehabilitation facility. This case highlights the importance of early diagnosis, rapid immunological evaluation, and aggressive immunosuppressive therapy in managing rapidly progressive interstitial pneumonia in elderly patients. Individualized treatment plans based on overall health rather than biological age can significantly improve outcomes, even in critically ill elderly patients. Early initiation of multidisciplinary care is crucial to achieving remission and restoring quality of life in this challenging population.

Prognosis of Lung Transplantation in Patients with Acute Exacerbations of Interstitial Lung Disease: A Meta-Analysis Based on Cohort Studies

PURPOSE

This meta-analysis aimed to examine the prognosis of patients with acute exacerbation of interstitial lung disease (AE-ILD) treated with lung transplantation compared to those with stable interstitial lung disease (ILD).

METHODS

We conducted a detailed search in PubMed, Embase, Web of Science, and the Cochrane Library, with the primary outcomes being overall survival (OS), acute cellular rejection (ACR), primary graft dysfunction (PGD), and length of stay (LOS).

RESULTS

Five cohort studies were included in this meta-analysis, with 183 patients enrolled in the AE-ILD group and 337 patients in the stable-ILD group. The results showed that in regard to perioperative outcomes, the AE-ILD group did not differ from the stable-ILD group in the incidence of ACR (relative risks [RR] = 0.34, p = 0.44) and the incidence of PGD Ⅲ (RR = 0.53, p = 0.43), but had a longer LOS (mean difference = 9.15, p = 0.02). Regarding prognosis, the two also did not differ in 90-day OS (RR = 0.97, p = 0.59), 1-year OS (RR = 1.05, p = 0.66), and 3-year OS (RR = 0.91, p = 0.76).

CONCLUSION

Our study concluded that the efficacy of lung transplantation in patients with AE-ILD is not inferior to that of patients with stable ILD. Lung transplantation is one of the potential treatments for patients with AE-ILD.

Sustained Treatment Response after Intravenous Cyclophosphamide in a Patient with Therapy-Resistant COVID-19 Acute Respiratory Distress Syndrome: A Case Report

Treatment of acute respiratory distress syndrome (ARDS) represents a severe complication of coronavirus disease 2019 (COVID-19) infection and is often challenging in intensive care treatment. Potential positive effects of intravenous cyclophosphamide have been reported in interstitial lung diseases (ILDs). However, there are no data on the use of high-dose cyclophosphamide in therapy-resistant COVID-19 ARDS. We report the case of a 32-year-old male patient admitted to the intensive care unit (ICU) of the Medical University of Vienna due to severe COVID-19 ARDS who required venovenous extracorporeal membrane oxygenation (ECMO) with a total runtime of 85 days. Despite all these therapeutic efforts, he remained in a condition of therapy-resistant ARDS. Unfortunately, the patient was denied for lung transplantation. However, a significant improvement in his respiratory condition was achieved after the administration of an intravenous regimen of cyclophosphamide and prednisolone. After a period of consecutive stabilization, the patient was transferred to the normal ward after 125 days of intensive care treatment. There is a substantial lack of therapeutic options in therapy-resistant ARDS. Our case report suggests that cyclophosphamide may represent a new treatment strategy in therapy-resistant ARDS. Due to its severe adverse effect profile, cyclophosphamide should be used after careful evaluation of a patient's general condition.