Acute exacerbation of idiopathic pulmonary fibrosis triggered by Aspergillus empyema

Suzuki, Atsushi; Kimura, Tomoki; Kataoka, Kensuke; Matsuda, Toshiaki; Yokoyama, Toshiki; Mori, Yuta; Kondoh, Yasuhiro

doi:10.1016/j.rmcr.2018.01.004

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…The mortality rate of patients with AE-ILD was relatively high. For patients with IPF, 46% of deaths are secondary to AE and median survival period after AE is 3-4 months (49). And a high mortality rate (55.6%) was as well-seen in CTD patients with AE-ILD (14).…”

Section: Discussionmentioning

confidence: 97%

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Liang

Sun

et al. 2020

Front. Med.

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This study aimed at clarifying the prevalence, risk factors, outcome, and outcome-related factors of acute exacerbation of interstitial lung disease (AE-ILD) in patients with idiopathic inflammatory myopathy (IIM). Methods: Data of IIM patients who were admitted to the First Affiliated Hospital of Zhejiang University (FAHZJU) from September 2007 to September 2019 were retrospectively collected. And the IIM patients with AE-ILD formed the case group. In addition, age and sex matched IIM patients without AE-ILD were randomly selected to constitute the control group. A 1:2 case-control study and intragroup analysis were performed to identify risk factors for development of AE-ILD in IIM patients and unfavorable short-term outcome in AE-ILD patients through comparison, univariate and multivariate logistic regression analysis. Results: AE-ILD occurred in 64 out of 665 IIM patients (9.6%) with a short-term mortality rate of 39.1%. And the 64 IIM patients with AE-ILD formed the case group. Besides, 128 age and sex matched IIM patients without AE-ILD were randomly selected to constitute the control group. The retrospective case-control study revealed that elevated on-admission disease activity (P < 0.001), lower percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%, P = 0.013) and diagnosis of clinically amyopathic dermatomyositis (CADM, P = 0.007) were risk factors for development of AE-ILD in IIM patients. The following intragroup analysis indicated that elevated on-admission disease activity (P = 0.008) and bacterial infection (P = 0.003) were significantly correlated with the unfavorable short-term outcome of patients complicated with AE-ILD. In addition, combined use of steroid and disease modifying antirheumatic drugs (DMARDs, P = 0.006) was found to significantly reduce the short-term mortality in IIM patients with AE-ILD. Conclusion: AE-ILD is a less frequent but fatal complication in IIM patients with elevated on-admission disease activity, lower DLCO% and diagnosis of CADM working as risk factors, indicating the potential roles of autoimmune abnormality and hypoxia in development of AE-ILD. Elevated on-admission disease activity and bacterial infection could predict unfavorable short-term outcome of IIM patients with AE-ILD. A therapeutic regimen of steroid and DMARDs was found to reduce short-term death in these patients.

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Section: Discussionmentioning

confidence: 97%

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Liang

Sun

et al. 2020

Front. Med.

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“…The infection-induced AE of IIP accompanied respiratory symptoms, such as fever, a sore throat, and worsening dyspnea, all of which were observed in the present case. In one case report from Japan, the AE of IIP was triggered by Aspergillus empyema [ 12 ]. Therefore, cryptococcal pneumonia may have been the trigger for the AE of RA-ILD in the present case.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous occurrence of accelerated nodulosis in lungs, liver, and kidneys, and acute exacerbation of interstitial pneumonia in a patient with rheumatoid arthritis: an autopsy case report

et al. 2022

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Background Accelerated nodulosis (ARN) is a rare variant of rheumatoid nodules (RNs) that is characterized by a rapid onset or the worsening of RNs. It generally develops at the fingers in patients with rheumatoid arthritis (RA) receiving methotrexate (MTX). Few case reports have described ARN at an extracutaneous location. Case presentation An elderly patient with long-standing RA was admitted to our hospital with acute respiratory failure. Computed tomography upon admission showed diffuse ground-glass opacities superimposed with subpleural reticular shadowing and honeycombing and multiple nodules in the lungs and liver. Despite the discontinuation of MTX and introduction of an immunosuppressive regimen with pulse methylprednisolone followed by a tapering dose of prednisolone and intravenous cyclophosphamide, the patient died due to the acute exacerbation (AE) of RA-related interstitial lung disease (ILD) following the parallel waxing and waning of a diffuse interstitial shadow and pulmonary and liver nodules. At autopsy, RNs were scattered throughout both lung fields in addition to extensive interstitial changes. RNs were also detected in the liver and kidneys. The foci of cryptococcosis were mainly identified in alveolar spaces. Based on the clinical and pathological findings, these nodules were most consistent with ARN because of acute increases in the size and number of previously detected pulmonary nodules. Conclusion The present case is noteworthy because ARN was concurrently detected in multiple internal organs and may be associated with the AE of RA-related ILD.

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“…Die infektionsbedingte AE der IIP ging mit respiratorischen Symptomen wie Fieber, Halsschmerzen und sich verschlimmernder Dyspnoe einher, die alle im vorliegenden Fall beobachtet wurden. In einem Fallbericht aus Japan wurde die AE der IIP durch ein Aspergillus- Empyem ausgelöst [12]. Daher kann die Kryptokokken-Pneumonie im vorliegenden Fall der Auslöser für die AE der RA-ILD gewesen sein.…”

Section: Diskussion Und Schlussfolgerungunclassified

Gleichzeitiges Auftreten von beschleunigter Nodulose in Lunge, Leber und Nieren und der akuten Exazerbation einer interstitiellen Pneumonie bei einem Patienten mit rheumatoider Arthritis: ein Fallbericht aus der Autopsie

et al. 2022

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Hintergrund: Die beschleunigte Nodulose (ARN) ist eine seltene Variante von Rheumaknoten (RN), die durch ein schnelles Auftreten oder die Verschlimmerung von RN gekennzeichnet ist. Sie entsteht in der Regel an den Fingern von Patienten mit rheumatoider Arthritis (RA), die mit Methotrexat (MTX) behandelt werden. Es gibt nur wenige Fallberichte, in denen ARN an einer extrakutanen Stelle beschrieben wurde. Falldarstellung: Ein älterer Patient mit langjähriger RA wurde mit akutem Atemversagen in unser Krankenhaus eingeliefert. Die Computertomographie bei der Aufnahme zeigte diffuse Milchglastrübungen, die von subpleuralen retikulären Verschattungen und Wabenbildungen überlagert waren, sowie mehrere Knoten in der Lunge und der Leber. Trotz des Absetzens von MTX und der Einleitung einer immunsuppressiven Pulstherapie mit Methylprednisolon, gefolgt von einer ausschleichenden Prednisolon-Dosis und intravenösem Cyclophosphamid, verstarb der Patient an einer akuten Exazerbation (AE) der RA-bedingten interstitiellen Lungenerkrankung (ILD), die auf die parallele Fluktuation eines diffusen interstitiellen Schattens und der Lungen- und Leberknoten folgte. Bei der Autopsie waren, zusätzlich zu umfangreichen interstitiellen Veränderungen, RNs in beiden Lungenfeldern verstreut. RNs wurden auch in der Leber und den Nieren nachgewiesen. Die Herde der Kryptokokkose wurden hauptsächlich in den Alveolarräumen gefunden. Aufgrund der klinischen und pathologischen Befunde stimmten diese Knoten am ehesten mit einer ARN überein, da die Größe und Anzahl der zuvor entdeckten Lungenknoten akut zunahm. Schlussfolgerung: Der vorliegende Fall ist bemerkenswert, da ARN in mehreren inneren Organen gleichzeitig nachgewiesen wurde und in Verbindung mit der AE von RA-assoziierter ILD stehen kann.

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Acute exacerbation of idiopathic pulmonary fibrosis triggered by Aspergillus empyema

Cited by 6 publications

References 25 publications

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Simultaneous occurrence of accelerated nodulosis in lungs, liver, and kidneys, and acute exacerbation of interstitial pneumonia in a patient with rheumatoid arthritis: an autopsy case report

Gleichzeitiges Auftreten von beschleunigter Nodulose in Lunge, Leber und Nieren und der akuten Exazerbation einer interstitiellen Pneumonie bei einem Patienten mit rheumatoider Arthritis: ein Fallbericht aus der Autopsie

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