Idiopathic organizing pneumonia: a relapsing disease. 19 years of experience in a hospital setting.

BACKGROUND: Although organizing pneumonia (OP) is a common pathological finding, studies including a substantial number of patients with idiopathic forms from a unique center and a long follow-up are rare. OBJECTIVES: To determine patients with cryptogenic forms of organizing pneumonia (COP), in order to characterize their clinical course, to identify predictive factors for relapse and to assess their effect on outcome. METHODS: For a 19-year period, all histopathological reports from a community teaching hospital were reviewed, and OP was found in 210 lung specimens belonging to 197 patients. RESULTS: Thirty-three (17%) patients presented cryptogenic forms and 32 of them (97%) responded to steroid therapy. At follow-up, 14 patients presented no relapses (no-relapse group, NR) and 18 (56%) presented relapses (relapsing group, RG) that resolved with ulterior treatment. Multifocal opacities on chest X-ray (RG 83% vs. NR 36%, p = 0.02) appeared to be a predictor for relapse. Patients with relapses showed a shorter time span to chest X-ray normalization (RG 8 +/- 8 weeks vs. NR 13 +/- 9 weeks, p = 0.09) that became significant in patients with 3 or more relapses (multiple-relapse group, MR, 4 +/- 2 weeks vs. NR 13 +/- 9 weeks, p < 0.04). Although the initial prednisone dose was similar in patients with relapsing forms, its maintenance was shorter than in patients without relapses, showing a trend to significance (RG 4 +/- 3 weeks, NR 7 +/- 6 weeks, p = 0.09). Lower levels of lactate dehydrogenase and gamma-glutamyltransferase, although always within the normal range, were found in patients with relapsing forms. CONCLUSION: COP is a specific but infrequent form of OP with a good response to steroid therapy. Relapses are frequent and typical characteristics of COP which resolved with ulterior treatment. Multifocal opacities on chest X-ray and a shorter maintenance of the initial steroid dose may increase the risk of relapse.

Functional sequelae of tuberculous pleurisy in patients correctly treated.

STUDY OBJECTIVES: To assess the functional sequelae (FS) of patients with tuberculous pleurisy (TP), to analyze the influence of different factors in the occurrence of these FS, and, finally, to evaluate the relationship between the FS and roentgenographic sequelae. DESIGN: An observational, retrospective study. SETTING: A community teaching hospital in Alicante, Spain. PATIENTS AND METHODS: From April 1986 to July 2000, all patients with a firmly established diagnosis of TP, who had been functionally studied at the end of follow-up, were included in the study. A diagnosis of TP was considered to be definitive when the presence of granuloma on a pleural biopsy specimen was demonstrated or when a culture was positive for Mycobacterium tuberculosis in pleural fluid (PF) or tissue. The general characteristics of the study population and PF were compared in patients with or without restrictive FS (ie, FVC or TLC < 80%), looking for risk factors for developing this complication. RESULTS: Eighty-one of 150 patients who had been treated for TP were eligible for the study. At the end of follow-up, eight patients (10%) had a restrictive FS. These patients had a lower PF lactate dehydrogenase concentration (p < 0.001), a higher PF concentration of cholesterol (p < 0.03) and triglycerides (p < 0.03), and a higher percentage of lymphocytes (p < 0.04). A weak correlation was found between the FVC and the intensity of radiographic pleural thickening (r = - 0.298; p < 0.01). CONCLUSIONS: The FS in patients with TP is restrictive in type, infrequent, and usually mild. A higher PF lipid content or a more chronic inflammatory pleural reaction at diagnosis appear to be risk factors for developing a FS. The correlation between FS and roentgenographic sequelae is poor.

Organizing pneumonia adjacent to lung cancer: frequency and clinico-pathologic features.

In order to assess the frequency of peripheral organizing pneumonia (OP) in patients with resected lung tumours and to describe its differential features, a cross-sectional study with prospective data collection was realized in a community teaching hospital. Demographic and clinical data were collected from clinical records. The lung specimens removed with a curative purpose in 89 consecutive patients with lung tumours were studied and the clinical and pathological characteristics of patients with and without OP were compared. In 33 of 89 patients (37%) included, OP in the vicinity of neoplasm was found. Areas of other types of fibrosis were evident in 21 patients (24%). Male gender, smoker, epidermoid histological type and the presence of lipid pneumonia were found with a significant higher frequency in patients with OP. Although without significant differences, the presence of symptoms and the bronchial stenosis were found more frequently in patients with OP. In conclusion, OP pattern adjacent to lung cancer, frequently associated to lipid pneumonia, is a common pathological finding. Male gender, a history of tobacco use and epidermoid histological type appear as risk factors for developing this pathologic pattern. Given the lack of distinctive clinico-pathological features, cancer adjacent OP could be confounded with other etiologic forms of this fibrotic process.

Lymphangitic carcinomatosis as a cause of malignant transient pleural transudate.

Although it is generally accepted that a malignant transient pleural transudate may appear during the early stages of lymphatic obstruction, cases demonstrating such probability are rare in literature. A 67-year-old woman was admitted to hospital because a lymphangitic carcinomatosis and a transudative infrapulmonary pleural effusion with a cytology positive for adenocarcinoma. One month later the effusion keeps being positive for adenocarcinoma but exudative in character. Lymphatic obstruction appears as the cause of the initial transudative characteristics of the pleural effusion.

Respiratory failure secondary to organizing pneumonia in a patient with membranoproliferative glomerulonephritis and lung haemorrhage.

We report the case of a woman with membranoproliferative glomerulonephritis type I who presented with acute respiratory failure secondary to alveolar haemorrhage. The persistence of the respiratory failure, once the alveolar haemorrhage had ceased, was apparently due to diffuse alveolar damage in organization. The recognition of this proliferative reaction through the performance of transbronchial biopsy allowed the initiation of a correct treatment with which a favourable response was obtained.

Fatal, gold-induced pneumonitis.

We report in detail an experience with irreversible interstitial pneumonitis developed during gold sodium thiomalate therapy. Factors that could influence the unfavourable course of this adverse, usually reversible pharmacological reaction, are analysed, and the importance of early recognition and prompt discontinuation of the drug is emphasised.