Progressive Pulmonary Fibrocystic Changes of Both Upper Lungs in a Patient with Ankylosing Spondylitis

Kim, Do Youn; Ryu, Yon Ju; Lee, Jin Hwa; Chang, Jung Hyun; Kim, Yookyung

doi:10.4046/trd.2015.78.4.459

Cited by 7 publications

(8 citation statements)

References 12 publications

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“…Pleuropulmonary abnormalities in ankylosing spondylitis are associated with findings such as upper lobe fibrobullous disease, nonspecific interstitial changes, septal and pleural thickening [17,23]. Although proportions of interstitial pneumonias vary, nonspecific interstitial pneumonia prevailed in our patients with scleroderma and Sjögren's syndrome.…”

Section: Radiological Characteristicsmentioning

confidence: 74%

Pleuropulmonary manifestations of systemic autoimmune diseases: An 84-case series analysis

et al. 2020

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Introduction/Objective. The systemic autoimmune diseases (SAD) can cause a variety of pulmonary and pleural abnormalities. The aim of this paper is to review clinical and radiological characteristics of a series of patients with systemic autoimmune disease hospitalized at a tertiary level facility. Methods. In this retrospective study, we reviewed the clinical and imaging findings in patients diagnosed with SAD at the Teaching Hospital of Pulmonology during a nine-year period. Results. The 84 patients group (mean age of 53.8 years) consisted of 64 women and 20 men. Fifty-eight out of 84 patients suffered from collagen vascular disease (CVD) and 26/84 had systemic vasculitis. Fatigue was a dominant symptom (75.8% in CVD, and 69.2% in vasculitis). Cough, hemoptysis, and fever were more frequent in patients with vasculitis. Fibrosis was the most common radiological manifestation of CVD (26/58), followed by pleural effusion (18/58) and consolidation (10/58). Irregular opacities were dominant radiologic finding in vasculitis (10/26), followed by nodules (8/26). Histological confirmation of systemic autoimmune disease was obtained in 28.6% patients, in 58/84 patients the diagnosis was based on positive serologic test and clinico-radiological manifestations, in two cases, on clinical and radiological features according to defined criteria. Conclusion. Pleuropulmonary manifestations of systemic autoimmune diseases are usually expressed in the sixth decade of age, predominantly in women. Clinical findings and positive serologic tests suggest diagnosis of systemic autoimmune diseases. Fibrosis is the most common radiologic pattern found in almost a half of the patients with CVD and irregular opacities are most common findings in vasculitis. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175046]

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Section: Radiological Characteristicsmentioning

confidence: 74%

Pleuropulmonary manifestations of systemic autoimmune diseases: An 84-case series analysis

et al. 2020

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“…In one study including 26 patientswith AFBD, the most frequently isolated agent was Aspergillus fumigatus , followed by various mycobacterial species (including Mycobacterium kansasii, M. avium, M. fortuitum, and M. scrofulaceum ); other studies found other Aspergillus and Candida species [ 1 , 3 , 12 ]. Chronic colonization by Aspergillus species occurs in 50–60% of the patients with AS having lung structural disease, and 10–30% of these will develop disease [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Anti-bacillary treatment was performed for 9 months and concluded after confirmation of negative cultures in bronchial wash. Later, voriconazole was started to treat CCPA based on clinical, laboratory, and bronchial wash findings. AFBD, especially with cavitation features, can be erroneously diagnosed as pulmonary TB, particularly in patients under or previously submitted to AS biological treatment [ 14 ]. In the reported case, the patient had been under anti-TNF-α therapy for almost 2 years after negative TB screening and was no longer under that medication at the time of first observation.…”

Section: Discussionmentioning

confidence: 99%

“…Hemoptysis is the most frequent sign of aspergillus infection. In our medical literature review, the description of hemoptysis in patients with AS and aspergillosis was frequently encountered in the presence of aspergilloma [ 11 , 14 ]. In the reported case, the patient evidenced a mass-like lesion inside the LUL cavity most likely representing an aspergilloma and developed severe bleeding with massive hemoptysis.…”

Section: Discussionmentioning

confidence: 99%

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Apical fibrobullous lung disease in ankylosing spondylitis: case report and literature review

Alfaiate

Durão

Patrício

et al. 2022

European Clinical Respiratory Journal

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Ankylosing spondylitis (AS) is associated with several unique pulmonary manifestations such as apical fibrobullous disease (AFBD), which is a rare extra-spinal complication, predominantly occurring in advanced disease. Infectious complications and differential diagnosis of cavitated lung lesions may be challenging, particularly in patients already submitted to immunosuppression. In this report, we present a low body-mass-index 47-year-old male patient, ex-smoker, with AS and severe joint involvement, medicated in the past with anti-TNF-α therapy, who was diagnosed with AFBD and developed pulmonary tuberculosis and later chronic cavitary pulmonary aspergillosis. The patient died due to lung cavity major bleeding.

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“…Inaccurate differential diagnosis may result in unnecessary tuberculosis therapy. In addition, secondary fungal and bacterial infections such as primarily Aspergillus may also develop in these lesions [ 4 , 5 ]. Pulmonary apical fibrosis develops in about 2 decades and progresses very slowly [ 4 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Rapidly Progressive Pulmonary Apical Fibrosis and Parenchymal Destruction in a Patient with Ankylosing Spondylitis

Ulusoy

Tuna

Sayit

2020

Case Reports in Rheumatology

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Pulmonary apical fibrosis is a rare complication of ankylosing spondylitis (AS). The essential characteristics of this lesion are its very slow progression and frequently asymptomatic nature. Herein, we are presenting a patient with AS who rapidly developed pulmonary apical fibrosis in a 3-year period despite decreased musculoskeletal pains. The 60-year-old male applied with complaints of progressively increasing cough in the recent two years, dyspnea, and fatigue. He had no chronic disease except AS. He had no continuous medication except nonsteroid anti-inflammatory drugs for 2-3 days monthly since his musculoskeletal pains decreased in the recent years. His physical examination revealed reduced breath sounds in the upper zones of the right lung. Chest X-ray revealed increased diffuse opacity in the upper zones of the right lung. Thoracic high-resolution computed tomography showed a consolidation accompanied with traction bronchiectases compatible with chronic fibrosis in the upper lobe of the right lung. However, thoracic computed tomography of the patient performed 3 years ago did not reveal pulmonary apical fibrosis and parenchymal destruction. Biopsy revealed no finding of malignancy, granulomatous inflammation, or vasculitis. The results of cultures were negative. So, the patient was diagnosed as pulmonary involvement of AS, which developed in a 3-year period. This case has shown that extra-articular complications may continue to develop in patients with AS even if their musculoskeletal complaints have subsided. So, patients with AS should be followed up regularly with systemic examinations.

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Progressive Pulmonary Fibrocystic Changes of Both Upper Lungs in a Patient with Ankylosing Spondylitis

Cited by 7 publications

References 12 publications

Pleuropulmonary manifestations of systemic autoimmune diseases: An 84-case series analysis

Pleuropulmonary manifestations of systemic autoimmune diseases: An 84-case series analysis

Apical fibrobullous lung disease in ankylosing spondylitis: case report and literature review

Rapidly Progressive Pulmonary Apical Fibrosis and Parenchymal Destruction in a Patient with Ankylosing Spondylitis

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