Adult-Onset Still's Disease Misdiagnosed as Acute Fibrinous and Organizing Pneumonia: A Case Report and Literature Review

Adult-onset Stil's disease(AOSD)is a rare condition that lies between autoinflammatory syndrome and autoimmune disease.The main clinical manifestations include fever,chills,rash,joint swelling and pain,peripheral blood leukocytosis,splenomegaly,etc.It is a systemic disease affecting between 1 and 34 people per million.The average age of onset is 35 years old,with a slightly higher prevalence rate in women.Since AOSD lacks early specific symptoms and signs,non-specialist doctors have limited understanding of the disease,and patients are prone to clinical misdiagnosis,mistreatment,and delayed disease progression.This paper reports a patient whose AOSD was misdiagnosed as acute fibrinous and organizing pneumonia.

Imipenem/cilastatin-induced acute eosinophilic pneumonia:A case report

Rationale:Acute eosinophilic pneumonia(AEP)is an acute pulmonary illness caused by eosinophilic infiltration of the lung parenchyma.It can happen after using drugs such as daptomycin and minocycline.AEP induced by imipenem/cilastatin is a rare condition.Patient’s Concern:A 45-year-old male patient,who previously suffered from a urinary tract infection and treated with imipenem/cilastatin antibiotic,was presented to us with acute respiratory distress,soon after the initiation of the antibiotic.Computed tomography identified pulmonary infiltrates in the upper and middle lung fields and eosinophils were found to account for 36%of differential count of the broncho-alveolar lavage fluid.He also developed peripheral eosinophilia as the disease progressed.Diagnosis:AEP,secondary to imipenem/cilastatin therapy.Interventions:Steroid therapy was administered and imipenem/cilastatin antibiotic was discontinued.Outcomes:The patient improved completely following the therapy and had clear lung fields on follow-up.Lessons:Imipenem/cilastatin is an uncommon cause of AEP and requires close monitoring during therapy.

Establishment of a Predictive Diagnostic Model for Acute Mycoplasma Pneumoniae Infection in Elderly Patients with Community-acquired Pneumonia

We established a diagnostic model to predict acute Mycoplasma pneumoniae （M. pneumonia） infection in elderly Community-acquired pneumonia （CAP） patients. We divided 456 patients into acute and non-acute M. pneumoniae infection groups. Binary logistic regression and receiver operating characteristic （ROC） curves were used to establish a predictive model. The following independent factors were identified： age 〉 70 years; serum cTNT level 〉 0.0S ng/mL; lobar consolidation; mediastinal lymphadenopathy; and antibody titer in the acute phase 〉 1：40. The area under the ROC curve of the model was 0.923 and a score of 2 7 score predicted acute M. pneumoniae infection in elderly patients with CAP. The predictive model developed in this study has high diagnostic accuracy for the identification of elderly acute M. pneumoniae infection.

Two methods of lung biopsy for histological confirmation of acute fibrinous and organizing pneumonia:A case report

BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.

Acute Eosinophilic Pneumonia (AEP) Due to Daptomycin: Is Autoimmunity a Clinico-Pathophysiologic Bridge to AEP?

Daptomycin induced acute eosinophilic pneumonia is a rare and potentially life threatening condition characterized by rapid respiratory failure, pulmonary infiltrates and eosinophilia. Risk factors for acute eosinophilic pneumonia include smoking, environmental irritants or inhalants and certain medications such as Daptomycin [1]. In this review of literature, we aim to explore the potential triggers for developing acute eosinophilic pneumonia in patients exposed to Daptomycin. The exact immune mechanism for daptomycin induced AEP is unknown, however the current proposed mechanism describes a T helper 2 lymphocyte response to inactivated daptomycin in the pulmonary surfactant, which leads to eosinophilia. Disordered T regulatory cell function is seen in patients with certain cancers, allergies and autoimmune conditions. We propose that patients with these underlying risk factors may be at increased risk of developing AEP after becoming exposed to Daptomycin. Understanding potential risk factors is crucial for health care workers as it allows them to identify susceptible populations, explore preventative measures and treat accordingly.

Pandemic and modern medicine:Time to recognize and correct previous misconceptions

A sudden increase in the number of viral pneumonias with the onset of the COVID-19 pandemic revealed defects in the provision of medical care for acute pneumonia in the lungs.Localization of the inflammatory process and its functional consequences indicate the identity of all forms of acute pneumonia,regardless of the etiology,and the need to develop treatment principles based on the pathogenesis of the disease.

Clinical and Radiological Profile of Acute Fibrinous and Organizing Pneumonia： A Retrospective Study

Background： Acute fibrinous and organizing pneumonia （AFOP） is a unique pathological entity with intra-alveolar fibrin in the form of ＂fibrin balls＂ and organizing pneumonia. It was divided into rare idiopathic interstitial pneumonia according to the classification notified by American Thoracic Society/European Respiratory Society in 2013. As a rare pathological entity, it is still not well known and recognized by clinicians. We reviewed the clinical features of 20 patients with AFOP diagnosed in a teaching hospital. Methods： The medical records of 20 patients with biopsy-proven diagnosis of AFOP were retrospectively reviewed. The patients＇ symptoms, duration of the disease, comorbidities, clinical laboratory data, pulmonary function testing, radiographic studies, and the response to treatment were extracted and analyzed. Results： Fever was the most common symptom and was manifested in 90% of AFOP patients. For clinical laboratory findings, systematic inflammatory indicators, including C-reactive protein and erythrocyte sedimentation rate, were significantly higher than normal ill AFOP patients. In accordance with this increased indicators, injured liver functions were common in AFOP patients. Inversely, AFOP patients had worse clinical conditions including anemia and hypoalbuminemia. For pulmonary function testing, AFOP patients showed the pattern of restrictive mixed with obstructive ventilation dysfunction. For high-resolution computerized tomography （HRCT） findings, the most common pattern for AFOP patients was lobar consolidation which was very similar to pneumonia. However, unlike pneumonia, AFOP patients responded well to glucocorticoids. Conclusion： Patients with AFOP manifest as acute inflammatory-like clinical laboratory parameters and lobar consolidation on HRCT, but respond well to steroid.

Acute interstitial pneumonia caused by interleukin-2 and interferon α-2b therapy for renal cell carcinoma： a case report and clinical study

Interleukins and intert-erons are distinct groups of cytokines that are upregulated after viral infection in humans and have been recogmzed as having antltumor activity. For example, high-dose interleukin-2 （IL-2） has been used to treat malignant tumors, such as melanoma, in the clinic. In addition, interferon alfa-2b （IFNα-2b） has been applied extensively to treat hepatitis as well as renal cell carcinoma in the clinic.

Dynamic changes in blood cytokine levels as clinical indicators in severe acute respiratory syndrome

Objective To investigate the dynamic changes observed in serum levels of interleukins (ILs), tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1 ) in severe acute respiratory syndrome (SARS) patients.Methods Sixty-one cases of SARS with positive antibodies to SARS coronavirus (SARS-CoV) were classified into the following categories: initial stage (3-7 days), peak stage (8-14 days), and remission and recovery stage (15 -27 days). Forty-four healthy individuals were used as controls. Serum levels of ILs, TNF-a and TGF-p, were measured in all subjects. Serum antibodies to SARS-CoV were detected only in SARS cases.Results The mean concentration of serum IL - 6 in SARS patients did not differ from that in the control group in initial and peak stages, but became significantly higher in remission and recovery stage compared with the control group, initial and peak stages ( P<0. 01). The mean concentration of serum IL-8 in SARS patients did not differ from that of the control group in initial stage, but was significantly higher than control group in peak stage and remission and recovery stage ( P < 0. 05). And it was more significantly higher in remission and recovery stage than in peak stage ( P<0. 01). The mean concentrations of IL-16 and TNF-αin SARS patients were higher than those of the control group for every length of the clinical courses investigated, and were especially high in remission and recovery stage (P<0. 01). SARS patients experienced higher concentration of serum IL-13 compared with the controls in initial stage ( P < 0. 01), but returned to normal levels in peak stage and in remission and recovery stage. The mean concentration of serum IL-18 in SARS patients was significantly lower than that of the control group during all clinical courses ( P < 0. 05). The mean concentration of serum TGF-β1, in SARS patients was higher than that of the control group during all clinical courses. Although TGF-bbbbb1 in serum decreased in remission and recovery stage in SARS patients, the average was still higher than that of the control group (P<0. 01). Conclusions Most proinflammatory cytokines and TGF-β1, were elevated during the early phase of SARS, which may be associated with lung infiltration and proliferation. Concurrently, the mean concentration of serum IL-13 decreased gradually, and the mean concentration of serum IL-18 level in SARS patients was lower than that of the control group during all the courses of SARS, suggesting that the immune state of the patients with SARS was obviously abnormal. Observing the dynamic changes in blood cytokine levels can provide a scientific basis to assess pathogenesis and efficacy of clinical treatment of SARS.

A retrospective study of 78 patients with severe acute respiratory syndrome

Objective To summarize the clinical features of severe acute respiratory syndrome (SARS) and to discuss diagnosis and management of the disease.Methods A retrospective study was conducted on 78 cases of SARS referred to the Guangzhou Institute of Respiratory Diseases (GIRD) between December 22, 2002 and near the end of March 2003. Items reviewed cover all data concerning clinical manifestations, laboratory investigation and radiology.Results The patients in the study consisted of 42 males and 36 females, aged 20 -75 yrs (mean age 37. 5±11. 6 yrs), including 44 affected health-care professionals. Clinical symptoms seen in the group were fever (100.0%), cough (88.5%), and dyspnea (79.5%). There were 12 cases (15. 3%) with WBCs <4. 0 x109/L, 49 cases (62. 8%) ranging between (4. 0-10. 0) ×10~9/L and 17 cases (21. 8%) over 10. 0×10~9/L. The average was(7. 58 ?. 96) x 109/L, with 0. 75±0.14 (neutrophil) and 0.18±0.11 (lymphocyte). Chest films and CT scanning revealed changes related to pneumonia. The transmission of the disease was likely via close contact with contagious droplets. The prevalences of acute lung injury (ALI, in 37cases) and acute respiratory distress syndrome (ARDS, 21 out of 37 cases) were considerably high among the patients. Seven patients who developed ARDS complicated with multiple organs dysfunction syndrome (MODS) died.Conclusions A history of close contact, fever, sign of pneumonia by X-ray and normal-to-lowered WBC counts are favorable for the diagnosis of SARS. Recognition of ALI as the important index for critical SARS and comprehensive supportive management are of paramount in decreasing the mortality of the disease.

Measurement of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome and its clinical significance

Objective To investigate the changes of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome (SARS) and its clinical significance.Methods Subgroups of blood T lymphocytes in 93 patients with SARS were detected by flow cytometer. The results detected in 64 normal subjects and 50 patients with AIDS served as controls.Results The numbers of CD3 +, CD4 +, and CD8 + lymphocytes all significantly decreased in acute phase of patients with SARS [(722±533)/μl, (438 ±353)/μl, (307±217)/μl)] compared with those in normal controls [ (1527±470)/μl, (787±257)/μl, (633±280)/μl, all P<0. 01) ], which was different from what we observed in patients with AIDS who had decreased CD4 + [ (296±298)/μl] but increased CD8 + [ (818 ±566)/μl counts. The counts of CD3+, CD4+, and CD8 + lymphocytes decreased more apparently in patients with severe SARS. All the five patients who died had CD4 + counts less than 200/μl. As the patients' condition improved, CD3 +, CD4 +, and CD8 + counts gradually returned to normal ranges.Conclusion The damage of cellular immunity is probably an important mechanism of pathogenesis of SARS.

Clinical analysis of 45 patients with severe acute respiratory syndrome

Objective To explore the clinical and radiological features of severe acute respiratory syndrome (SARS).Methods Analysis of the clinical presentation, chest radiographs, course of disease and features of severe pneumonia in 45 SARS patients diagnosed at our hospital in Beijing between April 5 - 20, 2003. Also included is a summation of the clinical features of SARS.Results (1) SARS appears to have high infectivity; (2) the most common symptom is fever; (3) the count of leukocyte is normal or decreased; (4) most patients (35/45, 77.8%) had experienced a 24-hour fever prior to the abnormal chest X-ray changes which showed progression of pulmonary infiltrates within 48 hours in 71.1% (32/45) of the patients and, (5) the percentage of patients who developed severe pneumonia (24. 4%) is higher than those who developed typical pneumonia.Conclusion SARS is a disease with high infectivity and has its own clinical and radiological features. Early recognition, prompt isolation, and appropriate therapy are the key to combate this infection.

Mouth the mirror of lungs： where does the connection lie？

Periodontitis is the chronic destructive disease of the periodontium （Gums） caused by host bacterial interactions. The effect of such host bacterial interactions in oral cavity also evokes a systemic response. Numerous studies have found common mechanisms of destruction for periodontal diseases and other chronic diseases like diabetes mellitus, atherosclerosis, respiratory diseases, and adverse pregnancy outcomes. Oral colonization by respiratory pathogens appears to be a risk factor for development of respiratory diseases and oral interventions aimed at reducing oral bacterial count have resulted in reduced incidence of these reparatory illness. This reflects the importance of oral hygiene among patients with respiratory illness. This review highlights the association between periodontal diseases and respiratory diseases.