Prolonged SARS-CoV-2 Infection and Organizing Pneumonia in a Patient with Follicular Lymphoma, Treated with Obinutuzumab-Challenging Recognition and Treatment.

A Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) led to a pandemic outbreak in 2019. COVID-19's course and its treatment in immunocompromised patients are uncertain. Furthermore, there is a possibility of protracted SARS-CoV-2 infection and the need for repeated antiviral treatment. Monoclonal antibodies against CD20, which are used, among other things, in the therapy of chronic lymphocytic leukaemia and follicular lymphoma, can induct immunosuppression. We present a case report of a patient with follicular lymphoma, treated with obinutuzumab, who was diagnosed with prolonged, ongoing SARS-CoV-2 infection and related organizing pneumonia. The recognition and the treatment were challenging which makes this case noteworthy. Antiviral therapy with several medications was administrated to our patient and their temporary, positive effect was observed. Moreover, high-dose intravenous immunoglobulin was applied, because slowly decreasing IgM and IgG levels were observed. The patient also received standard treatment of organizing pneumonia. We believe that such a complex approach can create an opportunity for recovery. Physicians should be conscious of the course and treatment possibilities facing similar cases.

[Own experience in diagnosis and therapy in pulmonary Langerhans cell granulomatosis]. / Wlasne doswiadczenia w rozpoznaniu i leczeniu plucnej postaci ziarniniakowatosci komórek Langerhansa.

UNLABELLED: We have assessed 12 patients (2 females, 10 males) aged between 19 and 53 years (mean 38.3 +/- 10.3) diagnosed with LCG during 14-year period (1985-1998). All patients were smokers. Follow-up was from 6 to 132 months (mean 47.5 +/- 44.4). LCG diagnosis was confirmed by histology in 10 cases (9 lung, and 1 bone biopsy). In 2 patients the diagnosis was made on clinical grounds, including characteristic appearance on HRCT scans. Mean FVC was 78.9 +/- 15.9% of predicted, DLCO 64.1 +/- 22% of predicted. In 8 patients (67%) FVC or DLCO were below 80% of predicted. In 2 patients with histologically proven diagnosis, HRCT was not characteristic for LCG. The treatment was introduced in 8 patients (67%). Only 3 out of 8 patients initially treated with steroids responded to this treatment. In the rest treated patients, therapy was changed to cytotoxic agents. 3 patients died (1 after 2 years, and 2 after 11 years) 2 due to LCG and 1 due to pneumonia. CONCLUSION: HRCT appearance is not always characteristic in patients with histological diagnosis of LCG. Pulmonary involvement in LCG is frequently connected with lung function derangements. Response to steroids is poor, and switching to cytotoxic agents is often necessary.

[Pulmonary alveolar proteinosis]. / Proteinoza pecherzyków plucnych.

Pulmonary alveolar proteinosis (PAP) is a rare disease characterised by the accumulation of proteinaceous material within alveoli. In order to evaluate the clinical features and the course of PAP we reviewed 7 cases (2F/5M) diagnosed during a 11-year period (1989-1999). The mean age of patients was 40.7 +/- 11.2 years. Diagnosis was obtained by open lung biopsy in all cases. Clinical findings included dyspnea (43%), cough (28%) and crackles (28%). Lung function tests were normal in 5 cases and showed a moderate restrictive pattern in 1 and mild airflow obstruction in 1. Three patients had reduced Dlco (mean was 63% of predicted). Four patients had hypoxemia at rest. Chest X-ray revealed bilateral alveolar opacities (71%), involving perihilar areas and lower lobes. HRCT scans demonstrated diffuse ground glass opacities (83%) with interlobular septa thickening (50%). Three patients were treated with repeated segmental BAL (2 improved). The spontaneous partial remission occurred in 4.

Induced sputum in patients with interstitial lung disease: a non-invasive surrogate for certain parameters in bronchoalveolar lavage fluid.

Induced sputum is a useful non-invasive method for the assessment of airway and parenchymal lung diseases. This study aimed to compare induced sputum and bronchoalveolar lavage fluid (BALF) cellular composition and T-lymphocyte subpopulations in patients with interstitial lung disease. We evaluated 33 patients: 15 with sarcoidosis, 11 with hypersensitivity pneumonitis, and 7 with idiopathic pulmonary fibrosis. The percentage of macrophages was significantly lower in induced sputum than in BALF in sarcoidosis (P=0.005), and the percentage of neutrophils was higher in induced sputum than in BALF in sarcoidosis (P=0.001) and hypersensitivity pneumonitis (P=0.006). A significant correlation was found between the BALF and induced sputum CD4+, CD8+ subsets and the CD4+/CD8+ ratio in both the whole patient group (r(s)=0.80, r(s)=0.88, r(s)=0.88, P<0.001, respectively) and in the 3 subgroups. A strong correlation of the T-lymphocyte subsets in induced sputum and BALF in patients with interstitial lung disease shows that induced sputum may be a non-invasive surrogate for certain parameters in BALF in these patients.

Humoral immune response against mycobacterial antigens in bronchoalveolar fluid from tuberculosis patients.

Resistance to tuberculosis (TB) is cell-mediated but a humoral response is common and may be correlated with the lack of effective local cellular defense mechanisms. The goal of the study was to evaluate IgG, IgA, and IgM-mediated humoral immune response against 38-kDa+16-kDa and 38-kDa+lipoarabinomannan (LAM) mycobacterial antigens in bronchoalveolar fluid (BALF) from patients with pulmonary TB. Non-tuberculosis (NTB) patients were used as control. 179 BALF samples (56 TB and 123 NTB) were examined. Commercially available ELISA-based assays against proteins 38-kDa and 16-kDa or 38-kDa plus LAM were used. Three different dilutions of BALF: 1:1; 1:10, and 1:50 (100) were tested. Only the results obtained with the 1:10 dilution allowed distinguishing TB and NTB groups. The mean IgG level for 38-Da+LAM was significantly higher in the TB than that in the NTB group (P<0.0001). The mean IgA level for 38-kDa+LAM also was higher in the TB group (P<0.05). No difference was observed between TB and NTB groups in the titer of IgM antibodies. These findings indicate that TB is associated with the presence of detectable levels of antibodies in BALF. The antibody response is highly heterogeneous. This phenomenon results from the balance between pathogen and host immune system. The tests examined for detection of IgG in BALF can be used in combination with other diagnostic methods to increase diagnostic accuracy of pulmonary TB.

[Pulmonary manifestations of polymyositis and dermatomyositis: a report of 6 cases and a review of literature]. / Zmiany plucne u chorych na zapalenie wielomiesniowe lub skórno-miesniowe: opis 6 przypadków i przeglad pismiennictwa.

The group of 6 patients with interstitial pulmonary changes in the course of polymyositis or dermatomyositis treated in years 1986-1999 was assessed. In one woman pulmonary changes occurred ten years before other symptoms of the connective tissue disease. Lung function tests showed a restrictive ventilatory defect in all patients. High resolution computed tomography revealed different changes, from ground glass attenuation to honey--combing. Only one patient, probably with bronchiolitis obliterans organizing pneumonia, responded to corticosteroids. Four women died from respiratory failure. In 2 pneumomediastinum occurred, which is a rare complication.