Assuntos
Amilases/efeitos adversos , Asma Ocupacional/induzido quimicamente , Detergentes/efeitos adversos , Pulmão/efeitos dos fármacos , Neutrófilos/efeitos dos fármacos , Exposição Ocupacional/efeitos adversos , Saúde Ocupacional , Peptídeo Hidrolases/efeitos adversos , Pele/efeitos dos fármacos , Amilases/imunologia , Asma Ocupacional/diagnóstico , Asma Ocupacional/imunologia , Asma Ocupacional/fisiopatologia , Testes de Provocação Brônquica , Broncoconstrição , Feminino , Volume Expiratório Forçado , Humanos , Imunoglobulina E/imunologia , Testes Intradérmicos , Pulmão/imunologia , Pulmão/fisiopatologia , Pessoa de Meia-Idade , Neutrófilos/imunologia , Peptídeo Hidrolases/imunologia , Pele/imunologia , Capacidade VitalRESUMO
BACKGROUND: The intrathoracic manifestations of IgG4-related disease include a range of conditions and severity, and can on occasion cause acute respiratory failure as reported in the case described here. OBSERVATION: A 69-year-old male former smoker, was admitted to our hospital with dyspnea, fever, cough, fatigue, and a 3-month history of weight loss. He received high flow oxygen therapy and non-invasive ventilation for severe respiratory failure. Chest computed tomography revealed multifocal condensations and ground glass opacities, accompanied by thickening of the perilymphatic interstitium, mediastinal lymphadenopathy and bilateral pleural effusion. Elevated serum concentrations of IgG4 suggested an IgG4-Related Disease. He developed renal failure and underwent a renal biopsy. Histopathological analysis of which supported the diagnosis by showing dense lymphocytic infiltrate with a count of IgG4+ cells/hpf higher than 60, and storiform fibrosis - a swirling, "cartwheel" pattern of fibrosis which may have a patchy distribution. The patient responded well to steroid therapy. CONCLUSION: Although respiratory symptoms are usually mild in IgG4-relatd disease, thoracic features can evolve into acute respiratory failure with few extra thoracic manifestations.
Assuntos
Doença Relacionada a Imunoglobulina G4 , Doenças Pulmonares Intersticiais , Derrame Pleural , Idoso , Humanos , Imunoglobulina G , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/diagnóstico , Masculino , Tomografia Computadorizada por Raios XRESUMO
In a woman's life, asthma can affect her in a variety of ways, with the onset of premenstrual asthma currently under-diagnosed. It is estimated that about 20% of women with asthma have premenstrual asthma, which is more common in patients with severe asthma. Women with asthma are at high risk of exacerbations and of severe asthma. Asthma is the most common chronic disease during pregnancy with potential maternal and foetal complications. Asthma medications are safe for the foetus and it is essential to continue pre-existing treatment and adapt it to the progress of asthma during the pregnancy. Sex steroids modulate the structure and function of bronchial and immune cells. Understanding their role in asthma pathogenesis is complicated by the ambivalent effects of bronchodilating and pro-inflammatory oestrogens as well as the diversity of response to their association with progesterone. Menopausal asthma is a clinical entity and is part of one of the phenotypes of severe non-allergic and low steroid-sensitive asthma. Targeted assessment of the domestic and professional environment allows optimization of asthma management.
Assuntos
Envelhecimento/fisiologia , Asma/terapia , Medicina de Precisão/tendências , Pneumologia/tendências , Idade de Início , Asma/epidemiologia , Asma/etiologia , Feminino , Hormônios Esteroides Gonadais/fisiologia , Humanos , Menopausa/fisiologia , Medicina de Precisão/métodos , Gravidez , Pneumologia/métodos , Fatores de RiscoRESUMO
Chronic obstructive pulmonary disease, a disease of increasing incidence, is related mainly to smoking. Although symptoms only appear at adulthood, the disease can develop from early life events. For example, bronchopulmonary dysplasia, which occurs in preterm infants, is characterized by airspace enlargement and could lead to late lung consequences. Once the lesions are established, no curative treatment is available. Stimulating lung regeneration from endogenous stem cells is therefore an exciting research domain, particularly through the activation of the mesenchymal contingent located in the lung stem cell niche.