Distinct histopathology of acute onset or abrupt exacerbation of hypersensitivity pneumonitis

Hariri, Lida P.; Mino‐Kenudson, Mari; Shea, Barry S.; Digumarthy, Subba R.; Onozato, Maristela L.; Yagi, Yukako; Fraire, Armando E.; Matsubara, Osamu; Mark, Eugene J.

doi:10.1016/j.humpath.2011.06.001

Cited by 48 publications

(28 citation statements)

References 22 publications

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“…This is consistent with our latest report on positive antibody response specific to MI purified recombinant antigens in the serum samples from machinists presenting physician-diagnosed HP (Chandra et al 2015). While subacute/chronic HP in humans is characterized by strong increases of lymphocytes in BALF and interstitial infiltrate, in acute HP early increases in BALF neutrophils and neutrophilic lung lesions have been noted (Fournier et al 1985;Hariri et al 2012), in agreement with a Type III mechanism. Conclusive evidence, however, of a role for immune complexes in HP has not yet emerged.…”

Section: Discussionsupporting

confidence: 91%

“…However, consistent occurrence of these immune response events in the same combination and measure in acute HP is unclear. A recent study of five human acute HP cases and three subacute or chronic HP cases with acute exacerbations demonstrated pronounced neutrophilic infiltration, bronchiolocentric inflammation, and/or bronchiolitis obliterans in all eight cases (Hariri et al 2012). Limited controlled studies using animal models and appropriate causative antigens for farmers' HP have reported events characteristic of acute HP (Schuyler 1993;Hunninghake & Richerson 1998;Schuyler et al 2000).…”

Section: Discussionmentioning

confidence: 99%

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Early immunopathological events in acute model of mycobacterial hypersensitivity pneumonitis in mice

Johansson

Boivin

Yadav

2017

Journal of Immunotoxicology

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Prolonged exposure to antigens of non-tuberculous mycobacteria species colonizing industrial metalworking fluid (MWF), particularly Mycobacterium immunogenum (MI), has been implicated in chronic forms of hypersensitivity pneumonitis (HP) in machinists based on epidemiology studies and long-term exposure of mouse models. However, a role of short-term acute exposure to these antigens has not been described in the context of acute forms of HP. This study investigated short-term acute exposure of mice to MI cell lysate (or live cell suspension) via oropharyngeal aspiration. The results showed there was a dose-and timedependent increase (peaking at 2 h post-instillation) in lung immunological responses in terms of the pro-(TNFa, IL-6, IL-1b) and anti-inflammatory (IL-10) cytokines. Bronchoalveolar lavage and histology showed neutrophils as the predominant infiltrating cell type, with lymphocytes <5% at all timepoints or concentrations. Granulomatous inflammation peaked between 8 and 24 h post-exposure, and resolved by 96 h. Live bacterial challenge, typically encountered in real-world exposures, showed no significant differences from bacterial lysate except for induction of appreciable levels of interferon (IFN)-c, implying additional immunogenic potential. Collectively, the short-term mycobacterial challenge in mice led to a transient early immunopathologic response, with little adaptive immunity, which is consistent with events associated with human acute forms of HP. Screening of MWF-originated mycobacterial genotypes/variants (six of MI, four of M. chelonae, two of M. abscessus) showed both inter-and intra-species differences, with MI genotype MJY10 being the most immunogenic. In conclusion, this study characterized the first short-term mycobacterial exposure mouse model that mimics acute HP in machinists; this could serve as a potentially useful model for rapid screening of field MWF-associated mycobacteria for routine and timely occupational risk assessment and for investigating early biomarkers and mechanisms of this understudied immune lung disease. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Early immunopathological events in acute model of mycobacterial hypersensitivity pneumonitis in mice

Johansson

Boivin

Yadav

2017

Journal of Immunotoxicology

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“…AFOP has also been reported following hematopoietic stem cell transplantation and lung transplantation. 6,35,[38][39][40][41] A definitive diagnosis of AFOP should be made only on large biopsy specimens because organizing alveolar fibrin may be seen as a nonspecific reaction adjacent to other processes, such as abscesses, granulomas, or neoplasms, and to ensure the absence of otherwise diagnostic features of entities within the differential diagnosis of DAD, OP, and EP. 6,37,42 DAD may prominently feature organizing fibrin, but there should always be typical hyaline membranes, however focal, present.…”

Section: Diffuse Alveolar Damagementioning

confidence: 99%

Pulmonary Manifestations of Acute Lung Injury: More Than Just Diffuse Alveolar Damage

Hughes¹,

Beasley

2016

Archives of Pathology &Amp; Laboratory Medicine

136

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Context.— Acute pulmonary injury may occur as a result of myriad direct or indirect pulmonary insults, often resulting in hypoxemic respiratory failure and clinical acute respiratory distress syndrome. Histologically, most patients will exhibit diffuse alveolar damage on biopsy, but other histologic patterns may be encountered, such as acute eosinophilic pneumonia, acute fibrinous and organizing pneumonia, and diffuse alveolar hemorrhage with capillaritis. Objective.— To review the diagnostic features of various histologic patterns associated with a clinical picture of acute lung injury, and to discuss key features in the differential diagnosis. Data Sources.— The review is drawn from pertinent peer-reviewed literature and the personal experience of the authors. Conclusions.— Acute pulmonary injury is a significant cause of morbidity and mortality. In addition to diffuse alveolar damage, pathologists should be aware of alternate histologic patterns of lung disease that may present with a similar clinical presentation because this may impact treatment decisions and disease outcome.

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“…44 Importantly, all biopsies also showed a lymphocytic bronchiolitis with poorly formed nonnecrotizing granulomas more typical of subacute or chronic hypersensitivity pneumonia. The authors 43 also demonstrated a fibrinous air space exudate in 3 patients with established diagnoses of hypersensitivity pneumonia who experienced acute exacerbation of their symptoms. Autopsy of a patient who died during an episode of acute farmer's lung published more than 40 years earlier demonstrated similar alveolar exudates as well as a small-vessel vasculitis.…”

Section: Commentmentioning

confidence: 90%

“…Hariri and colleagues 43 recently described a fibrinous air space exudate in 5 patients thought to have acute hypersensitivity pneumonia that resulted from exposure to mold in 4 of them. The fibrinous exudate included occasional eosinophils and was accompanied by interstitial neutrophils, a combination of findings that overlaps with so-called acute fibrinous and organizing pneumonia.…”

Section: Commentmentioning

confidence: 99%

Hypersensitivity Pneumonia: Role of Surgical Lung Biopsy

Herbst

2012

Archives of Pathology &Amp; Laboratory Medicine

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Lung biopsy often plays a key role in identifying patients with hypersensitivity pneumonia, especially in the absence of a typical history. A 69-year-old woman with a 2-year history of unexplained dyspnea on exertion underwent surgical lung biopsy for diagnosis of diffuse lung disease thought to represent idiopathic pulmonary fibrosis. Her biopsy showed honeycomb change and fibroblast foci suggestive of usual interstitial pneumonia, but also showed areas of cellular interstitial pneumonia with chronic bronchiolitis and a pattern of granulomatous inflammation typical of hypersensitivity pneumonia. The classic features of hypersensitivity pneumonia in surgical lung biopsy are emphasized, including a bronchiolocentric cellular interstitial pneumonia, chronic bronchiolitis, and poorly formed nonnecrotizing granulomas. As illustrated in our patient, sometimes subtle histologic clues are key in separating hypersensitivity pneumonia from usual interstitial pneumonia and other forms of idiopathic interstitial pneumonia. Making the distinction is important given differences in treatment strategies and natural history.

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Distinct histopathology of acute onset or abrupt exacerbation of hypersensitivity pneumonitis

Cited by 48 publications

References 22 publications

Early immunopathological events in acute model of mycobacterial hypersensitivity pneumonitis in mice

Early immunopathological events in acute model of mycobacterial hypersensitivity pneumonitis in mice

Pulmonary Manifestations of Acute Lung Injury: More Than Just Diffuse Alveolar Damage

Hypersensitivity Pneumonia: Role of Surgical Lung Biopsy

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