Interstitial pneumonia combined with nocardia cyriacigeorgica infection:A case report

BACKGROUND Nocardia infection is a relatively uncommon disease,with no reports among patients with interstitial pneumonia.Due to its atypical clinical symptoms and chest computed tomography(CT)findings and the frequent yielding of negative results by conventional cultures,it poses challenges for timely diagnosis and treatment.CASE SUMMARY A 63-year-old female patient presented to our hospital in July 2022 with a 3-mo history of intermittent cough and poor appetite,accompanied by a 2-wk long duration of headaches.She had a previous medical history of interstitial pneumonia and was on oral prednisone and cyclosporine.Chest CT revealed the presence of newly developed round nodules.The diagnosis of Nocardia cyriacigeorgica infection was confirmed through metagenomic next-generation sequencing(mNGS)performed on bronchoalveolar lavage fluid.Targeted antiinfection therapy was initiated,resulting in symptom improvement and radiological resolution,further validating the mNGS results.CONCLUSION Nocardia cyriacigeorgica infection is a clinically rare condition that is primarily observed in immunocompromised patients.Its clinical and radiological manifestations lack specificity,but mNGS can aid in rapidly obtaining pathogenic information.Early initiation of targeted antimicrobial therapy based on mNGS results can improve patient prognosis.

End-of-life home care of an interstitial pneumonia patient supported by high-flow nasal cannula therapy:A case report

BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.

Risk Factors for Postoperative Acute Exacerbation of Idiopathic Interstitial Pneumonia Following Surgery for Primary Lung Cancer

Objective: Postoperative acute exacerbation of idiopathic interstitial pneumonia (IIP) is a serious complication in patients with lung cancer. This study was aimed to investigate risk factors for postoperative acute exacerbation of IIP in surgery for primary lung cancer. Method: We evaluated retrospectively 37 IIP patients combined with primary lung cancer who underwent lung resection for lung cancer from January 2006 and March 2010. Preoperative and perioperative clinical data were collected and analyzed. Results: Ten of 37 patients (27.0%) developed acute exacerbation of IIP after surgery for primary lung cancer and five patients (13.5%) died of progressive respiratory failure. There was no significant difference in preoperative clinical factors between acute exacerbation (AE) group and non-acute exacerbation (non-AE) group. In perioperative factors, the duration of anesthesia is significantly longer in AE group than in non-AE group. Conclusion: These data suggest that it is unable to predict postoperative acute exacerbation of IIP from preoperative clinical data. Perioperative and postoperative management might be important to prevent acute exacerbation of IIP combined lung cancer.

Lymphoid interstitial pneumonia—Another consideration for recurrent bacterial pneumonia in an HIV positive patient (A case report)

We present a 39-year-old female with HIV, medication non-compliance, and recurrences of bacterial pneumonia. She presented with a two-day bout of worsening shortness of breath, dyspnea and productive cough. A CT of the chest was notable for multi-lobular pneumonia. She underwent flexible bronchoscopy and biopsy which revealed lymphocytic interstitial pneumonitis. Conclusion: Recurrent bacterial pneumonia is a rare complication of lymphoid interstitial pneumonia (LIP) in HIV positive patients, and should be considered in the differential as a possible precipitator of recurrent pneumonia inan HIV positive patient.

Preoperative Serum Krebs Von Den Lungen-6 and Surfactant Protein-D Levels in Non-Small Cell Lung Cancer Patients with Interstitial Pneumonia

We retrospectively analyzed the prognostic significance of preoperative serum Krebs von den Lungen-6 (KL-6) surfactant protein-D (SP-D) levels in non-small cell lung cancer (NSCLC) patients with interstitial pneumonia (IP). We enrolled 41 NSCLC patients with IP who have undergone curative surgery. Prognostic significance of serum KL-6 and SP-D levels was examined. We found a significant relationship between serum KL-6 and SP-D levels in NSCLC patients with IP. However, the 5-year survival of patients with high serum KL-6 level was poor, whereas serum SP-D level was not related to patients’ survival. Univariate analysis revealed that there was a trend towards an association between serum KL-6 level and patients’ prognosis but this did not reach statistical significance. This might be due to small number of study patients. In conclusion, there is a possibility that serum KL-6 level is a prognostic marker regardless of the presence of IP.

Idiopathic Interstitial Pneumonias (IIPs): Review of Clinical, Radiographic and High-Resolution Computed Tomography (HRCT)

Making a confident diagnosis is a complex task for a specific form of interstitial lung disease and providing appropriate management in an attempt to achieve normalization of the disease can put up an alarming process for the clinicians. A set of diffuse and restrictive lung diseases incorporate with idiopathic interstitial pneumonias, showing inflammation and fibrosis of the interstitium due to parenchymal damage. High-resolution computed tomography (HRCT) has magnified the diagnostic standpoint in stepwise identification and classified various patterns in the evaluation of interstitial lung disease. The aim of our review is to elaborate clinical, radiographic and typical and atypical HRCT findings of idiopathic interstitial pneumonias by correlating with its differential diagnosis. Idiopathic pulmonary fibrosis is the most predominant idiopathic interstitial pneumonias and its diagnosis needs to omit all other well-known causes of interstitial lung diseases. According to the 2011 evidence-based guidelines, usual interstitial pneumonia can be diagnosed by HRCT when all criteria are fulfilled. Non-specific interstitial pneumonia is distinguished by bilateral patchy ground-glass opacities and irregular linear/reticular opacities. Respiratory bronchiolitis associated-interstitial lung disease and desquamative interstitial pneumonia show centrolobular nodules and ground-glass opacities as imaging patterns. Cryptogenic organizing pneumonia consists of patchy peripheral or peribronchial consolidations, while ground-glass opacities with tendency for migration, which is evolving to fibrosis, in acute interstitial pneumonia. Lymphoid interstitial pneumonia and idiopathic pleuro-parenchymal fibroelastosis are classified under rare idiopathic interstitial pneumonias. HRCT images help radiologists in diagnosis and mapping specific patterns of idiopathic interstitial pneumonias. This article reviews the stages of evolution in HRCT features for idiopathic interstitial pneumonias.

Interstitial Pneumonia in a 94-Year-Old Woman with MPO-ANCA Positive Vasculitis

The interstitial pneumonia (IP) associated with myeloperoxidase anti-neutrophil cytoplasmic autoantibody (MPO-ANCA) showed characteristic histology dominated by usual IP pattern. We showed a 94-year-old woman, whose prognosis was poor by severity of IP by MPO-ANCA associated vasculitis. The median age at diagnosis of IP by MPO-ANCA associated vasculitis was over 60 years, with a male predominance. Most patients died related to respiratory insufficiency. Our case would be the oldest patient in IP by MPO-ANCA associated vasculitis in the literature.

Anti-Aminoacyl tRNA Synthetases Antibodies in Japanese Patients with Interstitial Lung Disease

Objectives: In the present study, we have sought to establish the clinical and immunological characteristics of Japanese patients with interstitial lung disease (ILD). Methods: Serum samples from 35 patients of ILD were screened for autoantibodies using RNA and protein immunoprecipitation assays. Patients with or without serum antibodies to aminoacyl tRNA synthetases (ARS) were assessed clinically and compared. Results: Sera from 12 of 35 (34%) patients with ILD (mean age at onset = 49.7 yrs;range 27 - 65 yrs) were found to contain anti-ARS antibodies (anti-EJ: 3 patients;anti-OJ: 2 patients;anti-PL-12: 3 patients;anti-KS: 4 patients). Nine of the 12 (75%) were female. Six (50%) had Raynaud’s phenomenon, 5 (42%) had arthralgia/arthritis and four (33%) had rheumatoid factor. Lung biopsy specimens of 8 patients with anti-ARS antibodies were examined histologically in detail. The following was determined: Two patients had usual interstitial pneumonia;3 had non-specific interstitial pneumonia;one had organizing pneumonia;one had lymphocyte interstitial pneumonia and the remaining patient had desquamative interstitial pneumonia. Age at disease onset was significantly lower and the frequency of Raynaud’s phenomenon was significantly greater in these patients compared to anti-ARS-negative patients (49.7 yrs vs. 62.6 yrs, p = 0.004;50% vs. 4%, p = 0.003, respectively). Conclusions: These results indicate that the presence of anti-ARS autoantibodies correlates with ILD without definite diagnosis of connective tissue diseases as well as polymyositis/dermatomyositis (PM/DM) with ILD in Japanese patients.

The Expression of Matrix Metalloproteinases and Tissue Inhibitors of Metalloproteinases in Idiopathic Interstitisal Pneumonia

Background: Idiopathic interstitial pneumonia is characterized by fibroblast proliferation and extracellular matrix (ECM) accumulation. Matrix metalloproteases (MMPs) and tissue inhibitors of metalloproteases (TIMPs) have been shown to regulate remodeling of the ECM, which indicates that they are important factors in the process of lung fibrosis. Therefore, we evaluated the expression of MMPs and TIMPs in tissues obtained from patients with idiopathic interstitial pneumonia and control tissues. Methods: Thirty-seven patients who were diagnosed with IIP (22: IPF, 13: NSIP, 2: COP) and 5 controls were enrolled in this study. The MMP-2 and -9 activity in lung tissue obtained from these patients was analyzed using gelatin zymography and the levels of TIMP-1 and -2 were measured by western blotting. We also evaluated the expression of MMP-2 and -9, as well as that of TIMP-1 and -2 in lung tissue using immunohistochemistry. Results: The levels of MMP-2 and MMP-9 were significantly increased in patients with IPF compared to those with NSIP and COP. The activities of TIMP-1 and -2 were also higher in patients with IPF than NSIP/COP patients and control subjects. There were no significant differences observed in the activities of MMPs and TIMPs obtained from patients with NSIP/COP and control subjects. The immunohistochemical analysis showed that TIMP-2 and MMP-2 were strongly stained at the fibroblasts of the fibroblastic foci in patients with IPF. Conclusions: These results suggest that over-expression of gelatinases and TIMPs in patients with IPF are important factors in the irreversible fibrosis that is associated with lung parenchyma.

Glucocorticoid pulse therapy in an elderly patient with post-COVID-19 organizing pneumonia:A case report

BACKGROUND Pulmonary fibrosis often occurs as a sequel of coronavirus disease 2019(COVID-19);however,in some cases,it can rapidly progress,similar to the acute exacerbation of interstitial lung disease.Glucocorticoids are the standard treatment for severe COVID-19 pneumonia requiring oxygen supply;however,the post-COVID-19 efficacy of high-dose steroid therapy remains unclear.Here,we presented a case of an 81-year-old man who developed acute respiratory failure after COVID-19 and was treated with glucocorticoid pulse therapy.CASE SUMMARY An 81-year-old man with no respiratory symptoms was admitted due to a diabetic foot.He had been previously treated for COVID-19 pneumonia six weeks prior.However,upon admission,he suddenly complained of dyspnea and required a high-flow oxygen supply.Initial simple chest radiography and computed tomography(CT)revealed diffuse ground-glass opacities and consolidation in both lungs.However,repeated sputum tests did not identify any infectious pathogens,and initial broad-spectrum antibiotic therapy did not result in any clinical improvement with the patient having an increasing oxygen demand.The patient was diagnosed with post-COVID-19 organizing pneumonia.Thus,we initiated glucocorticoid pulse therapy of 500 mg for three days followed by a tapered dose on hospital day(HD)9.After three days of pulse treatment,the patient's oxygen demand decreased.The patient was subsequently discharged on HD 41,and chest radiography and CT scans have almost normalized nine months after discharge.CONCLUSION Glucocorticoid pulse therapy may be considered when the usual glucocorticoid dose is ineffective for patients with COVID-19 sequelae.

CT定量分析在抗合成酶综合征合并间质性肺炎中的应用价值

目的探讨CT定量分析在抗合成酶综合征合并间质性肺炎(ASS-ILD)中的应用价值。方法回顾性分析2015-01至2022-06在武警特色医学中心呼吸科收治的ASS-ILD患者临床资料42例。CT影像利用定量软件自动分析,计算出肺总容积(TLV)和平均肺衰减值(MLA),计算出不同区域的体积和重量,以及其占肺总容积的百分比,然后分析CT定量指标与肺功能检查(PFT)参数的相关性,并对ASS-ILD中非特异性间质性肺炎合并机化性肺炎(NSIP/OP)和机化性肺炎(OP)两种类型的CT定量指标进行对比分析。结果用力肺活量占预计值百分比(FVC%)和第一秒用力呼气容积占预计值百分比(FEV_(1)%)与-500~-100 HU区域CT值呈正相关(r=0.58,P=0.048;r=0.79,P=0.01),FEV_(1)/FVC与-950~-500区域CT值呈负相关(r=-0.23,P=0.01),均具有统计学意义(P<0.05)。NSIP/OP组不良通气体积(V_(fibrosis)%)高于OP组(P=0.03),一氧化碳弥散量(DLCO%)明显低于OP组(P=0.01);OP组的过度通气体积(V_(hyper)%)和过度通气重量(W_(hyper)%)较NSIP/OP组高(P<0.05);NSIP/OP组总肺平均衰竭值(MLA_(total))明显高于OP组(P<0.01)。结论HRCT定量分析指标与PFT参数有较好的相关性,可用于肺功能的评估,并对NSIP/OP和OP的类型判定有参考价值。

表柔比星联合环磷酰胺致2级间质性肺病1例

目的:为肿瘤患者安全使用表柔比星联合环磷酰胺治疗(即EC方案)提供参考。方法:临床药师参与1例罕见EC方案致CTCAE(common terminology criteria for adverse events,不良事件通用术语标准)评价为2级间质性肺病患者的救治,并检索PubMed、Elsevier Science Direct、中国知网、万方等数据库查阅表柔比星、环磷酰胺致肺病案例,分析患者不良反应特点及治疗经过。结果:临床药师参考文献资料,建议医师暂停患者全身化疗,并经呼吸科专家会诊,给予泼尼松治疗,患者间质性肺病缓解。结论:临床药师应对恶性肿瘤患者加强药学监护,及时发现药物导致的不良反应,并参考文献资料,提出合理化建议,保障患者用药安全、有效。

隐源性和继发性机化性肺炎诊断的研究进展

机化性肺炎(OP)是一种以远端气腔内炎性纤维栓的存在为主要病理表现的肺部病变,根据病因分为隐源性机化性肺炎(COP)和继发性机化性肺炎(SOP)。基于COP和SOP在治疗与管理方面的差异性,二者的尽早诊断极其重要。OP包括损伤、机化、重建的过程,COP的病因未知,SOP的病因包括药物、感染、结缔组织病等。COP和SOP在临床表现方面无特异性,溯因性的实验室检查对于SOP查找病因具有重要参考价值。二者典型的CT表现是多灶性实变,非典型表现呈现多样性,需要注意与其他疾病的鉴别诊断。组织病理学是OP诊断的主要标准,包括经典型和特殊类型(急性纤维素性OP和瘢痕型OP),其特征可与影像学模式相对应,且为SOP病因查找提供线索。多学科团队对于临床、实验室检查、影像及病理信息的综合分析,对于COP和SOP的诊断与管理极其重要。

抗Th/To抗体阳性间质性肺炎急性加重报道1例并文献复习

目的分享1例抗Th/To抗体阳性间质性肺炎急性加重的临床表现及诊治经过,了解抗Th/To抗体的临床意义,为临床诊疗提供参考。方法收集1例抗Th/To抗体阳性间质性肺炎急性加重患者的临床资料,包括患者的性别、年龄等一般信息以及临床表现、实验室检查和影像学特点;结合文献复习,对临床资料进行分析。结果患者女,75岁,因“胸闷气喘7 d”于2023年7月31日收治入院。胸部HRCT显示间质性肺炎,ANA 1︰320,ENA(-),抗中性粒细胞抗体PANCA(甲醛敏感)(+),唇腺活检病理(-),肌炎抗体谱提示Th/To抗体阳性,查体面部、上肢皮肤色深,技工手,无明显皮肤硬化表现,四肢肌力正常,考虑结缔组织疾病相关间质性肺炎急性加重。予糖皮质激素联合环磷酰胺治疗后逐渐好转出院。结论抗Th/To抗体是一种核仁抗体,阳性患者常见于局限性硬皮病,内脏受累较轻,但常伴有间质性肺炎和肺动脉高压。对于间质性肺炎患者可积极完善肌炎抗体谱检查,在充分评估患者病情后慎重选择支气管镜检查。

斯鲁利单抗注射液致间质性肺炎不良反应1例分析

目的 分析斯鲁利单抗注射液致肺损伤发生率及相关风险因素,为临床用药提供参考。方法 对1例斯鲁利单抗注射液致间质性肺炎不良反应患者的临床资料进行分析,并对国内外文献进行回顾总结。结果 本例患者使用注射用奈达铂及依托泊苷注射液联合斯鲁利单抗注射液进行化疗,在联合化疗第2个疗程(即总第3个化疗疗程)出现间质性肺炎不良反应,经关联性分析判断为斯鲁利单抗注射液所致。文献分析显示斯鲁利单抗注射液致肺损伤不良反应的发生率为1.6%~8.2%,相关风险因素主要有吸烟史、烟草暴露史、患者的体能状态不良、年龄、肺部基础疾病及肺部放疗史等,推荐用于65岁以下患者。结论 临床应注意斯鲁利单抗注射液间质性肺炎风险,用药前充分评估患者的潜在风险因素,尽早预防,用药期间密切关注患者呼吸系统症状,一旦怀疑药物相关性肺损伤应及时复查患者肺部影像学、肺功能及动脉血气等,并评估其严重程度,及时做出处理,以降低患者用药风险。

从伏邪论治机化性肺炎合并吸烟相关性间质性肺疾病医案

机化性肺炎(OP)是指肺泡腔、肺泡管或伴有细支气管管内肉芽组织栓形成为病理特征的非特异性炎症。其大部分病因不明,无特征表现,影像具有游走的特点,若合并吸烟相关性间质性肺疾病(SR-ILD),极易漏诊误诊。因其具有起病隐匿潜藏、遇感而发、病程缠绵、反复发作、难以治愈等特点,与伏邪极为相似,中医多将其归为“肺痿”“肺痹”等范畴。本文通过1例OP合并吸烟相关性间质性肺疾病的临床案例分析,从伏邪理论角度辨治,为治疗OP提供临床诊疗思路。

胺碘酮肺损伤的临床特点及治疗预后

目的胺碘酮是最常用的抗心律失常药物,间质性肺炎是其严重不良反应,本研究探讨胺碘酮致弥漫性间质性肺炎的临床特点及治疗预后。方法回顾性分析1例胺碘酮致弥漫性间质性肺炎的临床表现、影像特点、治疗及转归。结果本研究1例高龄男性患者,使用胺碘酮1.5个月后出现咳嗽、呼吸困难,病程发展迅速,快速出现Ⅰ型呼吸衰竭,经对症处理、停用胺碘酮、给予无创呼吸机辅助呼吸、激素等治疗后,临床症状消失。结论胺碘酮致弥漫性间质性肺炎的诊断应根据用药史、结合临床及影像学表现。治疗中应及时停用胺碘酮,对重症患者给予激素、呼吸机的使用是治疗成功的关键。

人工智能在特发性肺纤维化中的研究进展

特发性肺纤维化(IPF)是一种可致死的慢性进行性纤维化间质性肺炎。早期诊断并及时开始抗纤维化治疗是延长IPF病人生存时间的关键。人工智能(AI)技术能够从影像数据中自动学习人眼无法识别的特征,在计算机辅助检测(CAD)系统中的应用可以提供决策支持,有助于提高IPF的诊断准确性并预测疾病进展。就AI的相关概念及其在IPF诊断、疾病进展与预后预测以及药物治疗反应评估中的研究现状予以综述。

淋巴细胞间质性肺炎7例临床、CT影像学及病理特征分析

目的分析淋巴细胞间质性肺炎(LIP)的临床、CT影像学及病理特征。方法回顾性分析7例经病理确诊的LIP患者的临床、影像资料,所有病例均进行胸部薄层CT检查。结果7例LIP患者均为女性,4例表现为弥漫分布的斑片状磨玻璃影,其中3例伴有网格状影、小结节影;3例表现为局灶分布的斑片状磨玻璃影,其中1例局部夹杂小结节影。5例有多发薄壁含气肺囊肿,4例伴有纵隔淋巴结肿大。病理活检组织HE染色主要表现为肺间质内弥漫性淋巴细胞浸润,免疫组织化学染色主要提示CD3细胞和多克隆CD20细胞的增加。结论LIP为罕见病,好发生于女性干燥综合征患者,当肺部高分辨率CT呈斑片状磨玻璃影并多发薄壁含气肺囊肿改变,病理表现为肺间质弥漫性淋巴细胞浸润时,高度提示LIP。

临床药师参与1例前列腺癌患者应用奥拉帕利致间质性肺炎伴发热的治疗实践

目的:为发生奥拉帕利致间质性肺炎伴发热的前列腺癌患者用药监护提供参考。方法:对1例口服奥拉帕利片后出现间质性肺炎患者的诊疗过程进行分析,临床药师结合临床药学专业知识,从患者出现发热的原因、间质性肺炎的治疗措施等方面进行分析,提出抗肿瘤治疗调整方案,并实施全程药学监护。结果:患者出现间质性肺炎后应及时停药,并根据不良反应严重程度调整后续治疗剂量,临床药师参与诊疗过程后患者间质性肺炎症状改善明显。结论:奥拉帕利引起的间质性肺炎较少见,临床应注意用药监护、及时调整用药方案并进行对症治疗,同时还需注意药物相互作用对奥拉帕利血药浓度的影响。