Síndrome de linfocitosis infiltrativa difusa con neumonía intersticial en un paciente con VIH / Diffuse infiltrative lymphocytosis syndrome with interstitial pneumonia in a patient with HIV

El síndrome de linfocitosis infiltrativa difusa se produce en asociación con la infección por virus de la inmunodeficiencia humana; requiere cumplir con los criterios diagnósticos y descartar otras patologías infecciosas y autoinmunes. Se presenta el caso de una mujer de 47 años que consultó por edema parotídeo bilateral, síndrome sicca, tos y síndrome de impregnación. Se observó en la tomografía de tórax infiltrado en «vidrio esmerilado¼, parcheado y bilateral. Se realizó diagnóstico de virus de la inmunodeficiencia humana positivo y fibrobroncoscopia con lavado broncoalveolar sin desarrollo de patógenos. Se interpreta como neumonía intersticial linfoidea asociada a síndrome de linfocitosis infiltrativa difusa. Se inició terapia antirretroviral con buena evolución y desaparición de los síntomas y de los infiltrados pulmonares.

Diffuse infiltrative lymphocytosis syndrome occurs in association with HIV infection; it requires meeting the diagnostic criteria and ruling out other infectious and autoimmune pathologies. We present the case of a 47-year-old woman who consulted for bilateral parotid edema, sicca syndrome, cough and impregnation syndrome, which was observed in the chest tomography infiltrated in ground glass, patched and bilateral. A diagnosis of HIV positive and fiberoptic bronchoscopy with bronchoalveolar lavage was made without the development of pathogens. It is interpreted as lymphoid interstitial pneu monia associated with DILS. Antiretroviral therapy was started with good evolution and disappearance of symptoms and pulmonary infiltrates.

Progress of Research on Immune-related Pneumonia in Non-small Cell Lung Cancer / 肿瘤防治研究

In recent years, immunotherapy has made a breakthrough in the field of non-small cell lung cancer, reshaping the pattern of lung cancer treatment. However, with the wide application of immunotherapy in clinical practice, immune-related adverse events have attracted increasing attention. Immune pneumonia, as one of the immune-related toxic side effects of greatest concern, affects the treatment process and curative effect and can be a threat to life in serious cases. Given that immune pneumonia has a complicated pathogenesis and diverse clinical manifestations, strengthening the understanding of immune pneumonia is urgently needed. The treatment of immune pneumonia is limited, and additional therapeutic medicines are still awaiting exploration. Therefore, this paper summarizes the progress of the research on immune pneumonia in the treatment of non-small cell lung cancer.

Case analysis of a patient with osimertinib-induced interstitial pneumonia who re-used EGFR-TKI therapy / 中国药房

OBJECTIVE To explore the way to re-use epidermal growth factor receptor-tyrosine kinase inhibitors （EGFR-TKI） in patients with EGFR-TKI-induced interstitial pneumonia （IP）， using osimertinib as an example. METHODS The IP treatment regimen and re-use of EGFR-TKI regimen in a patient who developed IP after the use of osimertinib were analyzed. And a literature review was made by combining the characteristics of the cases which reported in the literature and the characteristics of this case. RESULTS The patient’s IP symptoms due to treatment with osimertinib had resolved after treatment. The patient’s IP symptoms also did not worsen after using almonertinib in combination with hormones as re-use of EGFR-TKI regimen. However， almonertinib was discontinued as the patient experienced disease progression. The adverse reactions of IP needed to be dealt with in time， the EGFR-TKI should be discontinued and symptomatic treatment should be given. CONCLUSIONS EGFR-TKI targeted therapy could be re-selected by replacing EGFR-TKI， adjusting the dose of EGFR-TKI， and using hormones in combination. EGFR-TKI-induced adverse drug reactions of IP are rare， but need to be observed closely. If other EGFR-TKI is used， close monitoring of adverse reactions and curative effects are also required in order to adjust the patient’s treatment plan in time.

Sjogren’s Syndrome with Interstitial Lung Disease

@#Sjogren’s syndrome (SS) is an autoimmune disease affecting exocrine glands with known properties to cause chronic systemic multi-organ disease involvement. It produced the typical features of sicca syndrome, but due to insidious onset of the disease, patient may present with complications of the condition at the initial presentation. We present a case of primary Sjogren’s syndrome (SS) who first presented with pulmonary manifestations and was subsequently diagnosed as Lymphocytic Interstitial Pneumonia (LIP). The patient was extensively investigated and received appropriate treatment modalities.

Clinical Profile of Connective Tissue Disease- related Interstitial Lung Diseases at a Tertiary Care Center in Western India

Connective tissue disorders (CTDs) are one of the common causes of interstitial lung diseases (ILDs). This prospective observational study included around 51 patients of CTD-ILDs, and their demographic, clinical, radiological, and laboratory profiles were studied. The most common type of CTD-ILD in our study is rheumatoid arthritis-related ILD. On high-resolution computed tomography (HRCT) thorax, nonspecific interstitial pneumonia (NSIP) was the most common pattern seen in 30 patients (59%), followed by usual interstitial pneumonia (UIP) seen in 20 patients (39%). Even though CTD-ILDs are similar to other idiopathic ILDs in clinical and radiological presentation, patients with CTDs have to be evaluated clinically and radiologically for early diagnosis. Early treatment initiation and pulmonary rehabilitation help in delaying the progression of disease. Among all ILDs, CTD-ILDs are associated with better prognosis and survival

Factores asociados al desarrollo de enfermedad pulmonar intersticial en esclerosis sistémica / Factors associated with the development of interstitial lung disease in patients with systemic sclerosis

Resumen Introducción: el compromiso pulmonar intersticial se presenta en 80% de las tomografías de tórax de pacientes con esclerosis sistémica (ES) y tiene gran impacto en la morbimortalidad. El objeti vo de este trabajo fue describir factores asociados al desarrollo de enfermedad pulmonar intersticial (EPI) en pacientes con diagnóstico de ES de nuestra división. Métodos: Se realizó un estudio retrospectivo, casos y controles, de pacientes seguidos entre 2005-2021 que cumplían criterios de ES. Se definió EPI al hallazgo de manifestaciones intersticiales en tomografía de tórax con cortes de alta resolución (TACAR): patrón neumonía intersticial no específica (NINE) o neumonía intersticial usual (NIU), y/o hallazgos en pruebas de función pulmonar (CVF menor al 80% y DLCO menor al 80%). Se identificaron pacientes con EPI (casos) y sin ella (controles). Se analizaron variables demográficas, clínicas y serológicas. Se calcularon medidas de porcentaje, media (DS) y mediana (RIQ) en cada variable. Se efectuó análisis univariado y multivariado, mediante regresión logística para establecer su asociación con EPI. Resultados: Se incluyeron 79 pacientes con ES, 31 con EPI. El análisis univariado demostró que el subtipo de esclerosis (según clasific ación Le Roy), las medidas de función pulmonar y positividad del anticuerpo anticentrómero fueron factores asociados en forma estadísticamente significativa con EPI. En el análisis multivariado solo la presencia de anticuerpos anti-centrómero fue estadísticamente significativa. Discusión: el análisis de los factores de riesgo para determinar desarrollo y progresión de daño pulmonar tiene vital importancia para una implementación temprana del tratamiento, lo que impactaría en la tasa de mortalidad de los pacientes con ES.

Abstract Introduction: interstitial lung involvement occurs in 80% of chest CT scans of patients with systemic sclerosis (SS) and has a great impact on morbidity and mortality. The aim of the study was to describe factors associated with the development of interstitial lung disease (ILD) in patients diagnosed with SS in our division. Methods: a retrospective case-control study of patients followed up between 2005-2021 who met the classification criteria for SS was performed. ILD was defined as the finding of interstitial manifestations on high-resolution chest tomography (HRCT): non-specific interstitial pneumonia pattern (NSIP) or usual interstitial pneumonia (UIP), and/or findings on pulmonary function tests (FVC less than 80% and DLCO less than 80%). Patients with ILD (cases) and without it (controls) were identified. Demographic, clinical and serological variables were analyzed. Percentage, mean (SD) and median (IQR) measurements were calculated for each variable. A univariate and multivariate analysis was performed using logistic regression to establish its association with ILD. Results: Seventy nine patients with SS were included, 31 with ILD. Univariate analysis showed that sclerosis subtype (according to Le Roy classification), lung function measures, and anticentromere antibody positivity were factors associated with ILD in a statistically significant way. In the multivariate analysis, only the presence of anti-centromere antibodies was statistically significant. Discussion: the analysis of risk factors to determine the development and progression of lung damage is of vital importance for an early implementation of treatment, which would impact the mortality rate of patients with SS.

Pragmatic Real-world Approach to Treat Diffuse Parenchymal Lung Disease in Logistically Constraint Situations: A Proposition

Understanding the etiology and the tempo of progression with inexorable and self-perpetuating fibrosis [identification of progressive-fibrotic (PF) phenotype of interstitial lung disease (ILD) (PF-ILD)] can help to decide the treatment of diffuse parenchymal lung disease (DPLD) in the real-world practice. An evidence-supported pragmatic approach has been forwarded for such circumstances.

Interstitial Lung Disease in Rheumatoid Arthritis: A Prospective Study at a Tertiary Care Center

Objective: The objective of this study was to evaluate the presence of interstitial lung disease (ILD) in rheumatoid arthritis (RA) and to determine the role of clinical, spirometry, and high-resolution computed tomography (HRCT) findings to facilitate early detection of ILD in RA. Materials and methods: This is a prospective study at a tertiary care hospital from February 2016 to June 2019. All patients satisfying the American College of Rheumatology (ACR) criteria for RA and having respiratory symptoms or signs were included. All patients had detailed history, clinical examination, laboratory evaluation, spirometry, and HRCT chest. Results: A total of 280 patients of RA with respiratory symptoms were evaluated, out of which 82 (29.29%) had pulmonary involvement. There were 70 women and 12 men. Rheumatoid factor was positive in 90.2% of patients while anti-CCP antibody was positive in 43.9%. Chest X-ray (CXR) showed bilateral haziness in 36.9%. HRCT findings revealed a usual interstitial pneumonia (UIP) pattern in 73.2% patients and 24% had an nonspecific interstitial pneumonia (NSIP) pattern. Spirometric evidence of lung involvement was present in 84.2% of these cases. 2D Echo showed pulmonary hypertension (PH) in 46.3% of patients. Conclusion: Screening for respiratory symptoms and signs is essential in the clinical evaluation of RA. CXR, HCRT chest, and spirometry can be used effectively to diagnose RA-ILD early.

Literature analysis of leflunomide-induced interstitial pneumonia / 中国药房

OBJECTIVE To study the clinical characteristics of leflunomide-induced int erstitial pneumonia （Lef-IP），and to provide reference for its clinical diagnosis ，treatment and prevention. METHODS Lef-IP cases published in domestic and foreign journals from January 2004 to June 2021 were collected. Relevant information of patients were extracted and analyzed retrospectively， including basic characteristics ，clinical manifestations ，imaging manifestations ，laboratory examinations ， histopathological examinations ，treatment and outcome. RESULTS A total of 54 Lef-IP patients from case reports of 24 publications were included ，with a median age of 61 years（9-83 years）. Pulmonary symptoms appeared from 3.3 weeks to 132.9 weeks（median time of 14.5 weeks）. Patients with a loading dose of leflunomide have a shorter median time to pulmonary symptoms appearing （7.5 weeks）. The main clinical manifestations were dyspnea （85.2％），cough（57.4％），fever（53.7％）. CT imaging examination showed 19 cases with ground-glass shadow in both lungs ，and 29 cases showed interstitial infiltration in both lungs on chest radiograph；blood gas analysis showed hypoxemia and hypocapnia ；the levels of C-reactive protein and Krebs von Den lungen- 6 （KL-6）increased；histopathological examination mainly showed interstitial pneumonia （8 cases），including 3 cases of diffuse alveolar injury ，4 cases of lymphocytes in bronchoalveolar lavage fluid ，and 1 case of noncaseating granuloma. After discontinued leflunomide and symptomatic treatment （antibiotics，hormones，colecenamine，plasma exchange ），35 patients（64.8％）recovered or improved their lung symptoms. Twelve patients （22.2％）died，and patients with fever may had a higher mortality rate （34.5％， P＝0.02）. CONCLUSIONS The main clinical manifestations of Lef-IP are dyspnea ，cough and fever. Loading doses of leflunomide should be avoided at the beginning of treatment. When lef-IP occurs ，leflunomide is discontinued and corresponding treatment is given，and most of the patients ’pulmonary symptoms can return to normal or be improved.

HISTOLOGICAL SPECTRUM OF NON-NEOPLASTIC LESIONS IN THE LUNG-A RETROSPECTIVE STUDY DONE ON LOBECTOMY SPECIMENS

To study the histolopathological spectrum of non-neoplastic lesions of lung and to evaluate in relation to age, gender and clinico-radiological findings. This study is done over a period of 1 year (Nov 2020 to Nov 2021) in the Department of Pathology, LNMC, Bhopal. Total of 33 lobectomy specimens were studied. Specimens were fixed in formalin and paraffin embedded H&E-stained tissue sections were studied. Special stains (Gomorri's methenamine silver stain and Periodic acid Schiff stain) were done where ever required. Non-neoplastic lesions from 3 (9.09%) women and 30 (90.90%) men, with a median age of 43.86 (Interquartile range: 23-60 years) were collected. Fibrotic interstitial changes comprised the most common category of histologic findings, noted in 20 (60.6%) patients. Most cases consisted of usual interstitial pneumonia (UIP) (30.30%), followed by smoking related interstitial fibrosis/SRIF (desquamative interstitial pneumonia like patterns and respiratory bronchiolitis like pattern) (12.12%), non-specific interstitial pneumonia (NSIP) (9.09%) and patterns of “undefined” fibrosis (6.06%) such as peribronchial fibrosis, organizing pneumonias and other patterns of fibrosis that did not fall into a recognized category of idiopathic interstitial pneumonia. Granulomatous pathology was identified in 4 (10.81%) patients. On chest X-ray/CT scan chest, majority of lung lesions presented as diffuse and patchy opacities with honeycombing and bronchiectasis. Cigarette smoking was associated with 4 lung lesions. Histopathologic classification plays an important role in separating variable forms of non-neoplastic lung lesions & further subcategorising idiopathic interstitial pneumonia into clinically meaningful categories have important differences in natural history, prognosis, and treatment

Síndrome de Hamman - rich: Reporte de caso / Hamman-Rich Syndrome: case report

Resumen La neumonía intersticial aguda, también conocida como síndrome de Hamman-Rich, se caracteriza por la presencia de insuficiencia respiratoria aguda, hallazgo imagenológico de infiltrados difusos bilaterales del parénquima pulmonar y daño alveolar difuso en histopatología pulmonar. Es una patología con una mortalidad mayor al 50% debido a la falta de una terapia específica más allá del manejo sintomático y soporte ventilatorio. Se expone el caso de un paciente masculino de 56 años quien se presenta con síntomas respiratorios inespecíficos, deterioro progresivo de la oxigenación y hallazgo de opacidades en vidrio esmerilado difusas bilaterales. Además, biopsia pulmonar en la que se evidencia daño alveolar difuso en fase fibroproliferativa en quien se descarta proceso infeccioso, enfermedades autoinmunes y toxicidad medicamentosa, por lo que se hace el diagnóstico. Recibió manejo con pulsos de metilprednisolona con recuperación completa del cuadro. MÉD.UIS.2021;34(3): 103-8.

Abstract Acute interstitial pneumonitis, also known as Hamman Rich syndrome, characterised by acute respiratory failure, bilateral lung infiltrates on radiographs and diffuse alveolar damage (DAD) on lung histopathology, is an exclusion diagnosis which requires a complete study of other possible etiologies of DAD. It is a pathology with a mortality greater than 50% due to not having a specific therapy beyond symptomatic management and ventilatory support. We present a case of a 56 year old male with respiratory symptoms, who has progressive worsening oxygen levels and bilateral ground glass opacities on chest images. Lung biopsy with diffuse alveolar damage, infection, autoimmune diseases, and drug adverse reaction were ruled out. Managed with mechanical ventilation and high dose systemic corticoids with complete recovery. MÉD.UIS.2021;34(3): 103-8.

Neumonía Intersticial con características autoinmunes (IPAF): Reporte de casos / Interstitial pneumonia with autoimmune features (IPAF): Case reports

IPAF agrupa individuos con EPID y otras características clínicas, serológicas o pulmonares que derivan de una condición autoinmune sistémica subyacente, pero no cumplen con los criterios reumatológicos actuales para una ETC. La EPID, manifestación clínica frecuente de las ETC, puede aparecer en el contexto de una ETC conocida pero no es infrecuente que sea la primera y única manifestación de un ETC oculta. Identificar una ETC subyacente en pacientes que presentan con compromiso intersticial inicial puede ser un desafío; tales evaluaciones pueden optimizarse mediante un enfoque multidisciplinario. Presentamos el caso de tres pacientes, de diferente presentación, evolución y tratamiento, todos caracterizados hasta la fecha como IPAF.

IPAF groups individuals with ILD and other clinical, serologic, or pulmonary manifestations with an underlying systemic autoimmune condition, but do not meet current rheumatologic criteria for a CTD. ILD is a frequent clinical manifestation of CTDs; may appear in the context of a well known CTD but is often the first and only manifestation of an unknown CTD. Identifying an underlying CTD in patients presenting with initial interstitial involvement can be challenging; such evaluations can be optimized using a multidisciplinary approach. We present the case of three patients, of different presentation, evolution and treatment, all characterized to date as IPAF.

Spontaneous remission of follicular bronchiolitis with nonspecific interstitial pneumonia: A case report and literature review / 北京大学学报(医学版)

A 41-year-old female patient was admitted in Department of Respiratory and Critical Care Medicine, Peking University Third Hospital because of having cough for a year. Multiple subpleural ground grass and solid nodules could be seen on her CT scan. Four months before admission, she began to experience dry mouth and eyes, blurred vision, finger joints pain, muscle pain and weakness in both lower limbs and weight loss. At the time of admission, the patient's vital signs were normal, no skin rash was seen, breath sounds in both lungs were clear, no rales or wheeze, no deformities in her hands, no redness, swelling, or tenderness in the joints. There was no edema in both lower limbs. Some lab examinations were performed. Tumor markers including squamous cell carcinoma (SCC) antigen, neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), Cyfra21-1, pro-gastrin-releasing peptide (proGRP), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199) were all normal. The antinuclear antibody, rheumatoid factor, antineutrophil cytoplasmic antibody, anti-dsDNA antibody, anti-Sm antibody, anti-SSA/SSB antibody, anti-ribonucleoprotein (RNP) antibody, anti-Jo-1 antibody, anti-SCL-70 antibody and anti-ribosomal antibody were all negative. The blood IgG level was normal. The blood fungal β-1.3-D glucose, aspergillus galactomannan antigen, sputum bacterial and fungal culture, and sputum smear test for acid-fast staining were all negative. Lung function was normal. Bronchoscopy showed the airways and mucosa were normal. To clarify the diagnosis, she underwent thoracoscopic lung biopsy, the histopathology revealed follicular bronchiolitis (FB) with nonspecific interstitial pneumonia (NSIP). She did not receive any treatment and after 7 months, the lung opacities were spontaneously resolved. After 7 years of follow-up, the opacities in her lung did not relapse. To improve the understanding of FB, a literature research was performed with "follicular bronchiolitis" as the key word in Wanfang, PubMed and Ovid Database. The time interval was from January 2000 to December 2018. Relative articles were retrieved and clinical treatments and prognosis of FB were analyzed. Eighteen articles concerning FB with complete records were included in the literature review. A total of 51 adult patients with FB were reported, including 18 primary FB and 33 secondary FB, and autoimmune disease was the most common underlying cause. Forty-one (80.4%) patients were prescribed with corticosteroids and/or immunosuppressive agents, 6 (11.8%) patients were treated with anti-infective, 5 (9.8%) patients did not receive any treatment. The longest follow-up period was 107 months. Among the 5 patients without any treatment, 1 patients died of metastatic melanoma, the lung opacities were unchanged in 1 patient and getting severe in 3 patients. In conclusion, FB is a rare disease, the treatment and prognosis are controversial. Corticosteroid and immunosuppressive agents could be effective. This case report suggests the possibility of spontaneous remission of FB.

Neumonía intersticial con características autoinmunes: reporte de caso / Interstitial Pneumonia with Autoimmune Features: case report

La neumonía intersticial con características autoinmunes por sus siglas en inglés, es una entidad en la que existe un compromiso pulmonar intersticial y hallazgos clínicos y paraclínicos que sugieren una enfermedad del tejido conectivo, aunque no cumplen criterios diagnósticos para ninguna de estas. Con fines de investigación, en el 2015 se describieron criterios para esta entidad, en los que se incluyeron características de los dominios clínicos, serológicos y morfológicos, con diversos patrones de compromiso pulmonar. En la actualidad, hay un aumento en el interés de esta entidad, pues algunos autores sugieren que se pueda tratar de una enfermedad autoinmune per se, cuyo órgano blanco principal sería el pulmón. Dado su reciente reconocimiento, son pocos los casos descritos en la literatura. Con el propósito de contribuir a la mejor identificación de esa entidad, presentamos el caso de una paciente de 68 años con afectación pulmonar en quien después de descartar otras causas se llegó al diagnóstico de neumonía intersticial con características autoinmunes al cumplir los criterios de cada dominio requerido. Se inició tratamiento con micofenolato mofetilo a dosis de 2,5 mg/día. En su evolución clínica, la paciente presentó mejoría y fue dada de alta con tratamiento ambulatorio(AU)

Interstitial pneumonia with autoimmune features is a condition in which patients can have clinical and serological findings suggesting of a connective tissue disease associated with an interstitial lung disease, nonetheless no criteria for an specific connective tissue disease are meeting. In 2015 classification criteria where proposed, the diagnosis is made in the presence of a combination of features from clinical, serological and morphological domain with various patterns of pulmonary involvement. Currently there is an increase in the interest of this condition, as some authors suggest that it can be an autoimmune pathology per se, whose main target organ would be the lung. Given its recent recognition, there are few cases described in the literature and therefore in order to contribute to the better identification of that entity, we present the case of a 65 year old patient with lung involvement in whom after ruling out other etiological causes reached the diagnosis of I Interstitial pneumonia with autoimmune by meeting criteria of each required domain(AU)

Neumonía intersticial linfocítica en una paciente con lupus eritematoso sistémico y síndrome de Sjögren secundario: reporte de caso y revisión de la literatura / Lymphocytic interstitial pneumonia in a patient with systemic lupus erythematosus and secondary Sjögren's syndrome: Case report and literature review

RESUMEN La neumonía intersticial linfocítica es una complicación, poco frecuente, asociada con el lupus eritematoso sistémico, sin embargo, con gran impacto en la calidad de vida. Se asocia con la presencia de anti Ro/SSA, anti La/SSB y con el diagnóstico de síndrome de Sjögren secundario. No es clara la estrategia terapéutica y la información existente está basada en reportes de caso sin disponibilidad de estudios adecuadamente diseñados. En el presente documento se expone el caso de una paciente con lupus eritematoso sistémico y síndrome de Sjögren secundario, que presentó una enfermedad pulmonar intersticial con características de neumonía intersticial linfocítica.

ABSTRACT Lymphocytic interstitial pneumonia is an infrequent complication associated with systemic lupus erythematosus and has a great impact on quality of life. It is associated with the presence of anti-Ro/SSA, anti-La/SSB, and the diagnosis of secondary Sjögren Syndrome. Its therapeutic strategy is not clear, and the existing information is based on case reports, with there being no properly designed studies available. The case is presented here of a patient with systemic lupus erythematosus and secondary Sjögren's syndrome, who also presented with interstitial lung disease with characteristics of lymphocytic interstitial pneumonia.

Lymphocytic interstitial pneumonia: computed tomography findings in 36 patients / Pneumonia intersticial linfocítica: achados na tomografia computadorizada em 36 pacientes

Abstract Objective: To analyze the computed tomography (CT) findings of lymphocytic interstitial pneumonia (LIP). Materials and Methods: We retrospectively reviewed the clinical and CT findings of 36 patients with LIP, including 25 women and 11 men, with a mean age of 52.5 years (age range, 22-78 years). Results: The main associated diseases with LIP were Sjögren syndrome (42%), human immunodeficiency virus infection (17%), amyloidosis (17%), Sjögren syndrome associated with secondary amyloidosis (11%), idiopathic (8%), and systemic lupus erythematosus (5%). The predominant CT abnormalities were multiple cystic airspaces (n = 35), small nodules (n = 15), ground-glass opacities (n = 13), bronchiectasis and/or bronchiolectasis (n = 8), and thickening of the bronchovascular bundles (n = 8). Other CT findings included reticular opacities (n = 7), calcified nodules (n = 4), airspace consolidation (n = 4), emphysema (n = 3), honeycombing (n = 3), lymph node enlargement (n = 2), mosaic attenuation pattern (n = 1), and cavitated nodules (n = 1). Conclusion: The main CT findings of LIP were multiple cysts, small nodules, and ground-glass opacities.

Resumo Objetivo: Analisar os achados da tomografia computadorizada da pneumonia intersticial linfocítica. Materiais e Métodos: Trinta e seis pacientes com diagnóstico de pneumonia intersticial linfocítica (25 mulheres, 11 homens; faixa etária de 22 a 78 anos; idade média de 52,5 anos) tiveram os achados clínicos e tomográficos revisados retrospectivamente. Resultados: As principais doenças associadas à pneumonia intersticial linfocítica foram síndrome de Sjögren (42%), infecção pelo HIV (17%), amiloidose (17%), síndrome de Sjögren associada a amiloidose secundária (11%), síndrome de Sjögren idiopática (8%) e lúpus eritematoso sistêmico (5%). As alterações predominantes na TC consistiram em múltiplos espaços aéreos císticos (n = 35), pequenos nódulos (n = 15), opacidades em vidro fosco (n = 13), bronquiectasias e bronquiolectasias (n = 8) e espessamento de feixes broncovasculares (n = 8). Outros achados da TC incluíram opacidades reticulares (n = 7), nódulos calcificados (n = 4), consolidação do espaço aéreo (n = 4), enfisema (n = 3), faveolamento (n = 3), linfonodomegalia linfática (n = 2), padrão de atenuação em mosaico (n = 1) e nódulos escavados (n = 1). Conclusão: Os principais achados tomográficos observados em pacientes com pneumonia intersticial linfocítica foram múltiplos cistos, pequenos nódulos e opacidades em vidro fosco.

Usual interstitial pneumonia - secondary vs idiopathic pulmonary fibrosis

Background: Interstitial Lung Diseases is a group of disorders where the pulmonary interstitium, alveolar structures and the small airways are affected. Identification of a specific pattern on HRCT, with a thorough clinical evaluation can help a physician in narrowing down the differential diagnosis for the underlying cause. Usual Interstitial Pneumonia (UIP) is a frequently identified pattern. Differentiating patients with definite UIP pattern, into IPF and non-IPF spectrums is important. Aim of this study is to compare UIP patients with a secondary cause vs Idiopathic Pulmonary Fibrosis.Methods: Statistically 33 patients having UIP pattern on HRCT were evaluated based on the history of extrapulmonary symptoms, environmental exposure, drugs and subsequent serology testing. Patients were divided into two groups - IPF and UIP with a secondary cause. Both groups were compared on various clinical parameters. Inferences were drawn from the same.Results: Total 66.6% patients were identified to have Idiopathic Pulmonary Fibrosis, 33.3% had UIP with a secondary cause. Majority of patients with a secondary cause had Connective Tissue Disorder (90.9%) and one patient of Chronic Hypersensitivity Pneumonitis (HP).Conclusions: Absence of extrapulmonary symptoms in UIP patients need no further investigations and can be diagnosed as a case of IPF. However, presence of extrapulmonary symptoms needs further evaluation to diagnose the underlying disease and start treatment for the same.

Impact of an interstitial lung disease service in the diagnosis and management of interstitial lung disease in Singapore

INTRODUCTION@#The current gold standard for diagnosing interstitial lung disease (ILD) involves an ILD clinic evaluation, followed by discussion in a multidisciplinary meeting (MDM). However, there is a paucity of data on the impact of ILD MDMs on the diagnosis and management of ILDs in Southeast Asia. We studied the clinical impact of the ILD service on the diagnosis and management of ILDs at a university-affiliated tertiary hospital in Singapore.@*METHODS@#A single-centre retrospective review was done on 97 consecutive patients referred for evaluation to the ILD service from March 2016 to August 2017.@*RESULTS@#Mean age of the patients was 67 ± 11 years. Gender distribution was almost equal (52% male), with a majority of never-smokers (63%). Mean forced vital capacity (FVC) was 1.81 ± 0.66 L (66% ± 20% predicted). The three commonest referral diagnoses were ILD of uncertain classification (n = 38, 39%), connective tissue disease-associated ILD (CTD-ILD) (n = 24, 25%) and idiopathic pulmonary fibrosis (IPF) (n = 16, 17%). Following evaluation by the ILD service, there was a change of diagnosis in 60 (62%) patients and a change of management in 71 (73%) patients. The majority of consensus MDM diagnoses were IPF (n = 35, 36%), CTD-ILD (n = 30, 30%) and others (n = 15, 15%). There was a significant prognostic separation between the IPF and non-IPF diagnoses made following evaluation by the ILD service.@*CONCLUSION@#The ILD service allowed for more precise subtyping of various ILDs. This is particularly useful for IPF patients, who can benefit from antifibrotic therapies.

A Review of Drug Therapy of Lung Cancer with Interstitial Lung Disease / 中国肺癌杂志

Interstitial lung disease (ILD) is a risk factor for lung cancer. Patients with lung cancer associated with ILD (LC-ILD) often appear clinically. During the treatment of LC-ILD, there is a risk of causing acute exacerbation or even death in the treatment of lung cancer. At the same time, combining ILD has become the exclusion criteria for prospective clinical trials of most lung cancers. Therefore, when lung cancer is combined with ILD, it often becomes a difficult point for the treatment of lung cancer. Because LC-ILD patients have a certain proportion in the clinic, it is necessary to explore the best treatment options. Here we review the results of existing clinical studies for reference.

Uso de ultrasonido pulmonar para la detección de neumonía intersticial en COVID-19 / Lung ultrasound for the identification of COVID-19 pneumonia

Resumen La infección por SARS-CoV-2 tiene como manifestación clínica la enfermedad conocida como COVID-19. Si bien el conocimiento de la naturaleza de la enfermedad es dinámico, publicándose cada día decenas de artículos científicos sobre nuevas características de COVID-19, la presentación típica es la de neumonía intersticial. A pesar de la gran cantidad de información que se ha desarrollado en las últimas semanas, se ha estimado que esta enfermedad puede llegar a tener hasta un 72% de infradiagnóstico, por lo que se requieren herramientas clínicas que sean simples, de fácil acceso, que incrementen la detección de casos de forma factible y que arrojen información con valor pronóstico. Ante esta necesidad, han surgido algunas propuestas para poder realizar el diagnóstico, seguimiento y respuesta al tratamiento de los pacientes con COVID-19, tales como el ultrasonido pulmonar (USP). Cabe mencionar que el USP ha probado ser una técnica eficiente y de fácil reproducibilidad para diagnosticar insuficiencia cardiaca y patologías pleuro-pulmonares, sobre todo en pacientes críticamente enfermos. La evidencia de la utilidad de USP en COVID-19 es aún escasa, aunque de forma preliminar, parece ser una técnica sensible cuyos hallazgos tienen una elevada gold-standard. En esta breve revisión haremos énfasis en sus aspectos técnicos, las ventajas y desventajas, y por último una propuesta para el abordaje en este tipo de pacientes.

Abstract The SARS-CoV-2 infection has as a clinical manifestation the disease known as COVID-19. Although knowledge of the nature of the disease is dynamic, with dozens of scientific articles being published every day about new features of COVID-19, the typical presentation is that of interstitial pneumonia. Despite the large amount of information that has been developed in recent weeks, it has been estimated that this disease can have up to 72% underdiagnosis, which requires clinical tools that are simple, easily accessible, and increase the detection of cases in a feasible way and that yield information with prognostic value. Given this need, some proposals have emerged to be able to diagnose, monitor and respond to the treatment of patients with COVID-19, such as pulmonary ultrasound (USP). It is worth mentioning that the USP has proven to be an efficient and easily reproducible technique for diagnosing heart failure and pleuro-pulmonary pathologies, especially in critically ill patients. Evidence of the usefulness of USP in COVID-19 is still scarce, although preliminary, it seems to be a sensitive technique whose findings have a high gold standard. In this brief review we will emphasize its technical aspects, the advantages and disadvantages, and finally a proposal for the approach in this type of patient.