RESUMEN
An 83-year-old man with a history of interstitial lung disease (ILD) presented with a 1-week history of progressive dyspnea. Computed tomography of the chest revealed right lung-predominant, diffuse, ground glass opacities superimposed upon reticular opacities. Despite methylprednisolone pulse therapy under a diagnosis of acute exacerbation (AE) of ILD, lung involvement and renal dysfunction worsened and disseminated intravascular coagulation developed. The patient died on day 5 of hospitalization. Pathological examination at autopsy revealed diffuse alveolar hemorrhage (DAH) superimposed upon organizing diffuse alveolar damage and usual interstitial pneumonia. We reached a final diagnosis of DAH-predominant AE of idiopathic pulmonary fibrosis (IPF). Abundant expression of the oxidative stress marker hemeoxygenase-1 (HO-1) was observed in alveolar macrophages. These suggest that HO-1 expression in the lungs may offer a useful biomarker for this atypical histological subtype of AE of IPF.
RESUMEN
Miliary lung metastases have been reported to be frequently observed in nοn-small cell lung cancer (NSCLC) with major EGFR mutations, which consist of exon 19 deletion and exon 21 L858R. However, it remains undetermined whether NSCLC with minor EGFR mutations possesses characteristics similar to those with major EGFR mutations. In the present study, two cases of miliary lung metastases from NSCLC with exon 20 insertion were reported. Both the patients visited our hospital because of cough and/or dyspnea and were treated with chemotherapeutic agents, including platinum-doublet regimen. In addition, 1 patient received afatinib during the clinical course. However, all therapeutic regimens did not result in the desired outcome, and the respiratory condition rapidly deteriorated. Both the patients succumbed to disease within 3 months from the beginning of the 1st-line treatment due to disease progression. To conclude, chest physicians should be aware that miliary lung metastases could develop in NSCLC patients with exon 20 insertion and present a dismal prognosis.