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Clinical characteristics of hypersensitivity pneumonitis:non-fibrotic and fibrotic subtypes

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Chinese Medical Journal 2023年第23期136卷 2839-2846页

作者： Xueying Chen Xiaoyan Yang Yanhong Ren Bingbing Xie Sheng Xie Ling Zhao Shiyao Wang Jing Geng Dingyuan Jiang Sa Luo Jiarui He Shi Shu Yinan Hu Lili Zhu Zhen Li Xinran Zhang Min Liu Huaping Dai Department of Pulmonary and Critical Care Medicine Center of Respiratory MedicineChina-Japan Friendship HospitalNational Center for Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesInstitute of Respiratory MedicineChinese Academy of Medical SciencesPeking Union Medical CollegeBeijing 100029China Department of Pulmonary and Critical Care Medicine Center of Respiratory MedicineChina-Japan Friendship HospitalCapital Medical UniversityBeijing 100029China Department of Radiology China-Japan Friendship HospitalBeijing 100029China Department of Pathology China-Japan Friendship HospitalBeijing 100029China Institute of Clinical Medical Sciences Center of Respiratory MedicineChina-Japan Friendship HospitalBeijing 100029China

Background:The presence of fibrosis is a criterion for subtype classification in the newly updated hypersensitivity pneumonitis(HP)*** present study aimed to summarize differences in clinical characteristics and prognosis of non-fibrotic hypersensitivity pneumonitis(NFHP)and fibrotic hypersensitivity pneumonitis(FHP)and explore factors associated with the presence of ***:In this prospective cohort study,patients diagnosed with HP through a multidisciplinary discussion were *** data included demographic and clinical characteristics,laboratory findings,and radiologic and histopathological *** regression analyses were performed to explore factors related to the presence of ***:A total of 202 patients with HP were enrolled,including 87(43.1%)NFHP patients and 115(56.9%)FHP *** with FHP were older and more frequently presented with dyspnea,crackles,and digital clubbing than patients with *** levels of carcinoembryonic antigen,carbohydrate antigen 125,carbohydrate antigen 153,gastrin-releasing peptide precursor,squamous cell carcinoma antigen,and antigen cytokeratin 21-1,and count of bronchoalveolar lavage(BAL)eosinophils were higher in the FHP group than in the NFHP *** lymphocytosis was present in both groups,but less pronounced in the FHP *** regression analyses revealed that older age,<20%of lymphocyte in BAL,and≥1.75%of eosinophil in BAL were risk factors for the development of *** patients developed adverse outcomes,with a median survival time of 12.5 months,all of whom had ***:Older age,<20%of lymphocyte in BAL,and≥1.75%of eosinophil in BAL were risk factors associated with the development of *** of patients with NFHP was better than that of patients with *** results may provide insights into the mechanisms of fibrosis in HP.

关键词： interstitial lung disease Hypersensitivity pneumonitis Clinical characteristics Fibrosis Prognosis

Unilateral pleuroparenchymal fibroelastosis as a rare form of idiopathic interstitial pneumonia:A case report

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World Journal of Clinical Cases 2020年第18期8卷 4186-4192页

作者： Jae-Ha Lee Hang-Jea Jang Jin-Han Park Hyun-Kuk Kim Sunggun Lee Ji-Yeon Kim Seong-Ho Kim Department of Internal Medicine Haeundae Paik HospitalInje University College of MedicineBusan 48108South Korea Department of Pathology Haeundae Paik HospitalInje University College of MedicineBusan 48108South Korea

BACKGROUND Pleuroparenchymal fibroelastosis(PPFE)is a rare idiopathic interstitial pneumonia characterized by predominantly upper lobe involvement with pleural fibrosis and subjacent parenchymal ***,there have been increasing reports of PPFE,and PPFE might coexist with other interstitial lung diseases in the lower lobe and upper ***,cases of unilateral PPFE are *** SUMMARY A 75-year-old Korean male presented to our hospital with chronic dry cough and exertional *** patient’s symptoms started 6 mo previously and had been gradually *** the time of presentation,he felt dyspnea when walking at his own *** findings suggested PPFE,but the lesion was localized in the upper lobe of the right *** multidisciplinary discussion,a transbronchial lung biopsy in the right upper lobe revealed collapsed alveoli with parenchymal fibroelastosis,and elastic van Gieson staining demonstrated septal elastosis with intra-alveolar collagenosis,which met the histopathologic criteria of definite *** multidisciplinary discussion in an experienced interstitial lung disease center,we confirmed the diagnosis of unilateral ***,we confirmed the progression of PPFE on radiologic findings during the followup *** Clinicians should consider PPFE,even in cases with unilateral,predominantly upper lung involvement in interstitial lung disease patients through multidisciplinary discussion.

关键词： interstitial lung disease Pleuroparenchymal fibroelastosis Progression Unilateral Multidisciplinary discussion Case report

Intravesically instilled gemcitabine-induced lung injury in a patient with invasive urothelial carcinoma: A case report

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World Journal of Clinical Cases 2020年第19期8卷 4652-4659页

作者： Xiao-Ming Zhou Cen Wu Xiu Gu Department of Respiratory and Critical Care Medicine Shengjing Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina Department of Respiratory and Critical Care Medicine Fourth Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina Department of Pulmonary and Critical Care Medicine Shengjing Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina

BACKGROUND Gemcitabine is a chemotherapy agent with relatively low toxicities,as a valid option for elderly patients with underlying ***-induced pulmonary toxicities are rare and various,ranging from self-limited episodes of bronchospasm to fatal,progressive,severe,interstitial pneumonitis and respiratory *** gemcitabine instillations are commonly used to reduce recurrence or progression for non-muscle-invasive bladder cancer or urothelial *** severe toxicities have been reported for the intravesical instillation is assumed to be completely separated from the systemic *** SUMMARY A 67-year-old patient received 30 cycles of intravesical gemcitabine instillation after transurethral resection and developed a 1-wk fever,cough,hemoptysis,and *** a thorough checkup,bilateral consolidation and infiltration of the lungs were documented and a percutaneous lung biopsy confirmed organizing pneumonia after treatment with broad-spectrum empirical antibiotics *** corticosteroids were administered,and pulmonary toxicity gradually *** Gemcitabine-induced pulmonary toxicities present with various *** spite of the rare pulmonary involvement by the intravesical gemcitabine instillation,health care professionals who administer gemcitabine chemotherapy in this way should monitor for gemcitabine-induced pulmonary toxicities,particularly in patients with high-risk factors.

关键词： Gemcitabine interstitial lung disease lung injury Organizing pneumonitis Urothelial carcinoma Case report Chemotherapy toxicity

Successful treatment of acute relapse of chronic eosinophilic pneumonia with benralizumab and without corticosteroids:A case report

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World Journal of Clinical Cases 2022年第18期10卷 6105-6109页

作者： Shimon Izhakian Barak Pertzov Dror Rosengarten Mordechai R Kramer Pulmonary Institute Rabin Medical CenterPetach Tikva 49100Israel Affiliated to Sackler Faculty of Medicine Tel Aviv UniversityRamat AvivIsrael

BACKGROUND Currently,the mainstay of chronic eosinophilic pneumonia(CEP)treatment is corticosteroids,usually with a favorable response and good ***,relapse is common,requiring long-term use of corticosteroids,with risk of significant treatment-related *** dire need to develop new treatments for patients with CEP,who are dependent on,or resistant to corticosteroids has led to exploring novel *** herein describe a patient with acute relapse of CEP,who was successfully treated with benralizumab,an IL-5 Rαantagonist that has demonstrated rapid anti-eosinophil action in patients with ***,only three recent patient reports on CEP relapse,also demonstrated successful treatment with benralizumab alone,without *** SUMMARY A 31-year-old non-smoking woman presented in our hospital with a 3 wk history of shortness of breath,dry cough and fever up to 38.3℃.Laboratory examination revealed leukocytosis 10240 K/μL,eosinophilia 900 K/μL and normal values of hemoglobin,platelets,creatinine and liver *** tomography of the chest showed a mediastinal lymphadenopathy and consolidations in the right upper and left lower *** was diagnosed,and the patient was treated with hydrocortisone intravenously,followed by oral prednisone,with prompt *** months later,she presented with relapse of CEP:aggravation of dyspnea,rising of eosinophilia and extension of pulmonary infiltrates on chest *** was treated with benralizumab only,with clinical improvement within 2 wk,and complete resolution of lung infiltrates following 5 *** Due to Benralizumab’s dual mechanism of action,it both neutralizes IL-5 Rαpro-eosinophil functions and triggers apoptosis of *** therefore maintain benralizumab can serve as a reasonable therapy choice for every patient with chronic eosinophilic pneumonia and a good alternative for corticosteroids.

关键词： Benralizumab Eosinophilic pneumonia interstitial lung disease Corticosteroid withdrawal Case report

Anti-melanoma differentiation-associated gene 5 and anti-Ro52 antibody-dual positive dermatomyositis accompanied by rapidly lung disease:Three case reports

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世界临床病例杂志 2023年第23期11卷 5580-5588页

作者： Wen-Zheng Ye Shan-Shan Peng You-Hong Hu Mu-Ping Fang Yu Xiao Department of Dermatology The Central Hospital of XiaoganXiaogan Hospital Affiliated to Wuhan University of Science and TechnologyXiaogan 432000Hubei ProvinceChina Department of Respiratory and Critical Care Medicine The Central Hospital of XiaoganXiaogan Hospital Affiliated to Wuhan University of Science and TechnologyXiaogan 432000Hubei ProvinceChina

BACKGROUND Clinically amyopathic deramatomyositis was manifested as the various cutaneous dermatomyositis(DM)manifestations without muscle ***-melanoma differentiation-associated gene 5(anti-MDA5)and anti-Ro52 antibody-dual positive clinically amyopathic DM patients are at a high risk of developing rapidly progressive interstitial lung disease,and they exhibit an immensely high half-year *** SUMMARY We presented three patients with anti-MDA5 and anti-Ro52 antibody-dual positive DM patients and we reviewed the previous studies on the link between anti-MDA5 and anti-Ro52 antibody-dual positive *** we aggressively treated these patients similarly,but they all exhibited different *** reviewed the importance of clinical cutaneous rashes as well as the pathogenesis and treatment in the dual positive anti-MDA5 and anti-Ro52 associated *** Patients with anti-MDA5 anti-Ro52 antibody-dual positive DM should be accurately diagnosed at an early stage and should be treated aggressively,thus,the patient’s prognosis can be significantly modified.

关键词： Case series Anti-melanoma differentiation-associated gene 5 Anti-Ro52 Clinically amyopathic dermatomyositis interstitial lung disease Case report

Danggui Niantong decoction ameliorates joint inflammation and cardiopulmonary injury in TNF-Tg mice

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Acupuncture and Herbal Medicine 2023年第4期3卷 333-342页

作者： Can Yang Tao Chen Mengjiao Ma Qiang Li Zhichao Liang Hao Xu Youhua Wang Ning Li Qianqian Liang Longhua Hospital Shanghai University of Traditional Chinese MedicineChina Spine Institute Shanghai University of Traditional Chinese MedicineChina Key Laboratory of theory and therapy of muscles and bones Ministry of EducationChina Jing’an District Center Hospital of Shanghai Fudan UniversityShanghaiChina Department of Cardiology Longhua HospitalChina Guanghua Hospital Shanghai University of Traditional Chinese MedicineChina

Objective:Rheumatoid arthritis(RA)is a common autoimmune disease characterized by multiple joint lesions and systemic *** Niantong decoction(DGNTT)has been clinically used for RA treatment;however,its beneficial effect on cardiopulmonary complications has not been ***:Female tumor necrosis factor-transgenic(TNF-Tg)mice were used to evaluate the therapeutic effects of DGNTT on arthritis and cardiopulmonary ***(MTX)served as a positive *** assessment of the joint sections was performed using hematoxylin and eosin(HE),Alcian Blue/Orange G,and tartrate-resistant acid phosphatase *** mass was assessed by micro-computed tomography,inflammatory infiltrates in the heart and lungs were evaluated by HE staining,cardiopulmonary fibrotic injury was identified by Masson’s trichrome staining,and hypertrophy of mouse cardiomyocytes was measured by wheat germ agglutinin(WGA)***:DGNTT mitigated the inflammation of the ankle joint synovium,decreased the number of osteoclasts,and increased the area of cartilage and bone mass in TNF-Tg *** addition,DGNTT decreased the infiltration of inflammatory cells into the lung and heart tissues,accompanied by a reduction in cardiopulmonary fibrosis and myocardial cell hypertrophy in TNF-Tg *** a positive control drug,MTX attenuated the pathological changes in joints,but had no beneficial effect on cardiopulmonary inflammation and fibrosis in TNF-Tg ***:DGNTT improved joint lesions and alleviated cardiopulmonary complications in TNF-Tg mice.

关键词： Cardiovascular system disease Danggui Niantong decoction interstitial lung disease Rheumatoid arthritis TNF-Tg mice

Diffuse lung involvement in rheumatoid arthritis:a respiratory physician’s perspective

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Chinese Medical Journal 2023年第3期136卷 280-286页

作者： Hui Huang Ruxuan Chen Chi Shao Zuojun Xu Paul J.Wolters Department of Pulmonary and Critical Care Medicine Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of Pulmonary and Critical Care Medicine University of CaliforniaSan FranciscoCA 94117USA

The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis(RA),which is reported to occur in up to 60%to 80%of RA *** complications are the second leading cause of death due to *** there is a wide spectrum of RA-associated respiratory diseases,interstitial lung disease is the most common manifestation and it impacts the prognosis of *** has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease(RA-ILD)and RA-associated respiratory diseases recently,for example,opportunistic pulmonary infectious diseases and toxicity from RA *** a chest physicians’perspective,we will update the diagnosis and treatment of RA-associated ILD,methotrexate-associated lung disease,and the complication of Pneumocystis jiroveci pneumonia in RA in this review.

关键词： interstitial lung disease lung Methotrexate pneumonitis Pneumocystis jiroveci pneumonia Rheumatoid arthritis

Genetic characterization of a Chinese family with familial idiopathic pulmonary fibrosis

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Chinese Medical Journal 2012年第11期125卷 1945-1951页

作者： ZHANG Xin JIANG Jun CHEN Wei-jun SU Long-xiang XIE Li-xin Department of Respiratory Medicine Hainan Branch of Chinese People's Liberation Army General HospitalSanyaHainan 572000China Department of Respiratory Medicine Chinese People's Liberation Army General HospitalBeijing 100853China Beijing Institute of Gcnomics Chinese Academy of SciencesBeijing 100101China

Background Idiopathic pulmonary fibrosis （IPF） is a chronic inflammatory interstitial lung disease with an unknown cause. Recent studies have shown that genetic factors play an important role in the pathogenesis of IPF. Methods To explore the genetic background of patients with IPF, a candidate gene approach was employed to screen for mutations in seven genes among members with familial IPF in mainland of China. Results Within six of the candidate genes, a total of 31 point mutations were identified. Among the missense mutations, the SFTPA1 exon 6 CAG〉AAG （GIn238Lys） and SFTPB exon 2 CAC〉CCC （His2Pro） mutations caused changes in the physical and chemical properties of amino acids. Each sequence alteration was identified in sporadic IPF patients, control specimens （pneumonia patients and healthy persons）. Genotype frequencies and allele frequencies of codon 238 in exon 6 of SFTPA1 were noted significantly higher in patients with IPF than those in other two control subjects. The computational protein structure prediction by protein homology modeling confirmed differences in three-dimensional structure between mutant SFTPA1 and original SFTPAI. Conclusions Although the functions of the mutant candidate genes vary, these genes may ultimately result in damage to alveolar epithelial cells, initiating the progress of pulmonary fibrosis. In particular, while pathophysiological mechanisms need to be illustrated, the GIn238Lys missense variant of exon 6 in the SFTPA1 may have potential susceptibility in the development of IPF, which was shown in patients with sporadic IPF with a statistically higher frequency.

关键词： idiopathic pulmonary fibrosis familial interstitial lung disease genetics Chinese

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World Journal of Gastroenterology 2007年第38期13卷 5151-5153页

作者： GL Gupte S Mahadevan JR Clarke H Alton SV Beath Liver Unit Birmingham Children's Hospital Steelhouse Lane B4 6NH United Kingdom Department of Respiratory Medicine Birmingham Children's Hospital Steelhouse Lane B4 6NH United Kingdom Department of Radiology Birmingham Children's Hospital Steelhouse Lane B4 6NH United Kingdom Liver Unit Birmingham Children’s Hospital Steelhouse Lane B4 6NH United Kingdom

Sirolimus is an immunosuppressant with expanding use in pediatric organ transplantation, dermatology and rheumatology. We report two cases of children who developed asthma like symptoms and were diagnosed with interstitial lung disease, which responded to discontinuation of sirolimus. Pediatricians should be aware about the pulmonary side effects of sirolimus.

关键词： Sirolimus Pulmonary toxicity interstitial lung disease Asthma Small bowel transplantation Intestinal transplantation Organ transplantation