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de Fonseka D, Arnold DT, Smartt HJM, Culliford L, Stadon L, Tucker E, Morley A, Zahan-Evans N, Bibby AC, Lynch G, Mishra E, Khan S, Haris M, Steer H, Lewis L, Ionescu A, Harvey J, Blyth K, Rahman NM, Edey AE, Rogers CA, Maskell NA. PET-CT-guided versus CT-guided biopsy in suspected malignant pleural thickening: a randomised trial. Eur Respir J 2024; 63:2301295. [PMID: 38097208 PMCID: PMC10831139 DOI: 10.1183/13993003.01295-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Pleural biopsy is the gold standard for diagnosis of pleural malignancy but a significant proportion will have an inconclusive biopsy despite ongoing clinical suspicion of malignancy. We investigated whether positron emission tomography-computed tomography (PET-CT) targeted pleural biopsy is superior to standard CT-guided pleural biopsy following an initial non-diagnostic biopsy. METHODS The TARGET trial was a multicentre, parallel group randomised trial. Patients with a previous inconclusive pleural biopsy but an ongoing suspicion of pleural malignancy were randomised (1:1) to receive either CT-guided biopsy (standard care) or PET-CT followed by a targeted CT biopsy (intervention). The primary outcome was pleural malignancy correctly identified from the trial biopsy. RESULTS Between September 2015 and September 2018, 59 participants were randomised from eight UK hospital sites: 29 to CT-only followed by targeted biopsy and 30 to PET-CT followed by targeted biopsy. The proportion of pleural malignancy correctly identified was similar between the groups (risk ratio 1.03 (95% CI 0.83-1.29); p=0.77). The sensitivity of the trial biopsy to identify pleural malignancy was 79% (95% CI 54-94%) in the CT-only group versus 81% (95% CI 54-96%) in the PET-CT group. CONCLUSIONS The results do not support the practice of PET-CT to guide pleural biopsies in patients with a previous non-diagnostic biopsy. The diagnostic sensitivity in the CT-only group was higher than anticipated and supports the practice of repeating a CT-guided biopsy following an inconclusive result if clinical suspicion of malignancy persists.
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Affiliation(s)
- Duneesha de Fonseka
- Academic Directorate of Respiratory Medicine, University of Sheffield, Sheffield, UK
| | - David T Arnold
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Helena J M Smartt
- Bristol Trials Centre, Medical School, University of Bristol, Bristol, UK
| | - Lucy Culliford
- Bristol Trials Centre, Medical School, University of Bristol, Bristol, UK
| | - Louise Stadon
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Emma Tucker
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Anna Morley
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | | | - Anna C Bibby
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Geraldine Lynch
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Eleanor Mishra
- University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Henry Steer
- Gloucestershire Hospitals NHS Trust, Gloucester, UK
| | - Leon Lewis
- Academic Directorate of Respiratory Medicine, University of Sheffield, Sheffield, UK
| | - Alina Ionescu
- Aneurin Bevan University Hospital Trust, Newport, UK
| | - John Harvey
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | | | - Najib M Rahman
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK
| | | | - Chris A Rogers
- Bristol Trials Centre, Medical School, University of Bristol, Bristol, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
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2
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Jones R, Steer H, Preston N, Perkins P. Malignant pleural effusions: the patient experience. BMJ Support Palliat Care 2023; 13:e254-e255. [PMID: 33707298 DOI: 10.1136/bmjspcare-2021-002958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Rachel Jones
- Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Henry Steer
- Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Nancy Preston
- International Observatory of End of Life Care, Lancaster University, Lancaster, UK
| | - Paul Perkins
- Sue Ryder Leckhampton Court Hospice, Cheltenham, Gloucestershire, UK
- Palliative Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
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Perry-Thomas R, Noble J, Rehman A, Steer H. What do we do with chest X-rays which are abnormal but not suspicious for lung cancer? Still a role for direct recall CT. Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wilshire CL, Chang SC, Gilbert CR, Akulian JA, AlSarraj MK, Asciak R, Bevill BT, Davidson KR, Delgado A, Grosu HB, Herth FJF, Lee HJ, Lewis JE, Maldonado F, Ost DE, Pastis NJ, Rahman NM, Reddy CB, Roller LJ, Sanchez TM, Shojaee S, Steer H, Thiboutot J, Wahidi MM, Wright AN, Yarmus LB, Gorden JA. Temporal Trends in Tunneled Pleural Catheter Utilization in Patients With Malignancy: A Multicenter Review. Chest 2020; 159:2483-2487. [PMID: 33307064 DOI: 10.1016/j.chest.2020.10.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/06/2020] [Accepted: 10/24/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Candice L Wilshire
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
| | - Shu-Ching Chang
- Medical Data Research Center, Providence St. Joseph Health, Portland, OR
| | - Christopher R Gilbert
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
| | - Jason A Akulian
- Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mohammed K AlSarraj
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC
| | - Rachelle Asciak
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Benjamin T Bevill
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | - Kevin R Davidson
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC
| | - Ashley Delgado
- Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Horiana B Grosu
- Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, TX
| | - Felix J F Herth
- Department of Internal Medicine, Pulmonology, and Critical Care Medicine, Thoraxklinik Universitatsklinikum Heidelberg, Heidelberg, Germany
| | - Hans J Lee
- Division of Pulmonary/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin E Lewis
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University, Nashville, TN
| | - David E Ost
- Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, TX
| | - Nicholas J Pastis
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Chakravarthy B Reddy
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT
| | - Lance J Roller
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University, Nashville, TN
| | - Trinidad M Sanchez
- Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA
| | - Samira Shojaee
- Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA
| | - Henry Steer
- Department of Respiratory Medicine, Gloucestershire Royal Hospital, Gloucester, UK
| | - Jeffrey Thiboutot
- Division of Pulmonary/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Momen M Wahidi
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC
| | - Amber N Wright
- Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lonny B Yarmus
- Division of Pulmonary/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jed A Gorden
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA.
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Corcoran JP, Psallidas I, Gerry S, Piccolo F, Koegelenberg CF, Saba T, Daneshvar C, Fairbairn I, Heinink R, West A, Stanton AE, Holme J, Kastelik JA, Steer H, Downer NJ, Haris M, Baker EH, Everett CF, Pepperell J, Bewick T, Yarmus L, Maldonado F, Khan B, Hart-Thomas A, Hands G, Warwick G, De Fonseka D, Hassan M, Munavvar M, Guhan A, Shahidi M, Pogson Z, Dowson L, Popowicz ND, Saba J, Ward NR, Hallifax RJ, Dobson M, Shaw R, Hedley EL, Sabia A, Robinson B, Collins GS, Davies HE, Yu LM, Miller RF, Maskell NA, Rahman NM. Prospective validation of the RAPID clinical risk prediction score in adult patients with pleural infection: the PILOT study. Eur Respir J 2020; 56:2000130. [PMID: 32675200 DOI: 10.1183/13993003.00130-2020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/06/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means of predicting at baseline presentation which patients will suffer a poor clinical outcome. A validated risk prediction score would allow early identification of high-risk patients, potentially directing more aggressive treatment thereafter. OBJECTIVES To prospectively assess a previously described risk score (the RAPID (Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)) score) in adults with pleural infection. METHODS Prospective observational cohort study that recruited patients undergoing treatment for pleural infection. RAPID score and risk category were calculated at baseline presentation. The primary outcome was mortality at 3 months; secondary outcomes were mortality at 12 months, length of hospital stay, need for thoracic surgery, failure of medical treatment and lung function at 3 months. RESULTS Mortality data were available in 542 out of 546 patients recruited (99.3%). Overall mortality was 10% at 3 months (54 out of 542) and 19% at 12 months (102 out of 542). The RAPID risk category predicted mortality at 3 months. Low-risk mortality (RAPID score 0-2): five out of 222 (2.3%, 95% CI 0.9 to 5.7%); medium-risk mortality (RAPID score 3-4): 21 out of 228 (9.2%, 95% CI 6.0 to 13.7%); and high-risk mortality (RAPID score 5-7): 27 out of 92 (29.3%, 95% CI 21.0 to 39.2%). C-statistics for the scores at 3 months and 12 months were 0.78 (95% CI 0.71-0.83) and 0.77 (95% CI 0.72-0.82), respectively. CONCLUSIONS The RAPID score stratifies adults with pleural infection according to increasing risk of mortality and should inform future research directed at improving outcomes in this patient population.
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Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Joint first authors, with equal contribution to study recruitment and manuscript writing
| | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Joint first authors, with equal contribution to study recruitment and manuscript writing
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francesco Piccolo
- Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Tarek Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | | | | | - Alex West
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Jayne Holme
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | | | - Henry Steer
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Nicola J Downer
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK
| | - Mohammed Haris
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Emma H Baker
- Institute of Infection and Immunity, St George's, University of London, London, UK
| | | | | | - Thomas Bewick
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Burhan Khan
- Dartford and Gravesham NHS Trust, Dartford, UK
| | - Alan Hart-Thomas
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | | | | | | | - Maged Hassan
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Chest Diseases Dept, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Anur Guhan
- University Hospital Ayr, NHS Ayrshire and Arran, Ayr, UK
| | | | - Zara Pogson
- United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Lee Dowson
- Royal Wolverhampton Hospital NHS Trust, Wolverhampton, UK
| | - Natalia D Popowicz
- Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Judith Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Neil R Ward
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Rob J Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Melissa Dobson
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Rachel Shaw
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Emma L Hedley
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Assunta Sabia
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Barbara Robinson
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
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6
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Barratt SL, Mulholland S, Al Jbour K, Steer H, Gutsche M, Foley N, Srivastava R, Sharp C, Adamali HI. South-West of England's Experience of the Safety and Tolerability Pirfenidone and Nintedanib for the Treatment of Idiopathic Pulmonary Fibrosis (IPF). Front Pharmacol 2018; 9:1480. [PMID: 30618768 PMCID: PMC6304353 DOI: 10.3389/fphar.2018.01480] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/03/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose: Pirfenidone and nintedanib are two novel antifibrotic agents licensed for the treatment IPF. Prior to being approved for use in England for patients with FVC >50% and <80%, these were made available for all IPF patients under the Mild Patient Program (MPP) and Patient In Need Scheme (PIN). Prescribing of these medications is restricted to specialist centers. We sought to characterize the population of patients prescribed antifibrotics and determine the drug tolerability of these medications in the Northern hub of the Southwest of England regional ILD network. Methods: A retrospective analysis of all patients treated with antifibrotics between August 2012 and July 2017 was undertaken. Baseline characteristics including patient demographics and pulmonary physiology, in addition to drug tolerability and reasons for treatment cessation were collated. Data were compared using unpaired student's t-test, Chi-squared, Mann-Whitney rank sum or ANOVA as appropriate. Logistic regression analysis evaluated clinical characteristics associated with discontinuation of pirfenidone therapy. P < 0.05 was considered statistically significant. Findings: A total of 164 patients, all with consensus diagnoses of IPF, were identified. Of these, 70.1% (115/164) received pirfenidone as their initial therapy. Baseline age, gender and pulmonary physiology did not differ significantly between groups. Drug discontinuation occurred most commonly due to adverse drug reactions events (ADRs) for both pirfenidone [40.0% (46/115)] and nintedanib [16.3% (8/49)]. Anorexia, rash and gastrointestinal disturbance were reported most commonly as the reason for cessation of pirfenidone; anorexia, nausea and weight loss for nintedanib. Duration of therapy prior to discontinuation because of ADRs did not differ significantly between medication groups but patients with a baseline FVC < 65% predicted, had a significantly shorter duration of pirfenidone prior to discontinuation due to ADRs, compared to those with a FVC 65-80% predicted. Multivariate logistic regression did not identify any independent baseline characteristics that predicted discontinuation of pirfenidone therapy prior to 52 weeks. Implications: Idiopathic pulmonary fibrosis (IPF) patients treated with nintedanib had comparable treatment emergent adverse event (TEAE) profiles in clinical practice to those reported in clinical trials. The TEAE profile of pirfenidone was higher than clinical trial data would suggest, although comparable to real-world datasets. Further work is required to explore the possible reasons underpinning this finding, including whether this is related to population co-morbidities or center threshold. No new safety concerns were identified.
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Affiliation(s)
- Shaney L Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
| | - Sarah Mulholland
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
| | - Khaled Al Jbour
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
| | - Henry Steer
- Gloucestershire and Cheltenham General Hospitals, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Markus Gutsche
- Gloucestershire and Cheltenham General Hospitals, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Noeleen Foley
- Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | | | - Charles Sharp
- Gloucestershire and Cheltenham General Hospitals, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Huzaifa I Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, United Kingdom
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Hameed F, Steer H. A case of bronchiolitis obliterans organising pneumonia associated with SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome. BMJ Case Rep 2017; 2017:bcr-2017-219822. [PMID: 28765183 DOI: 10.1136/bcr-2017-219822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 57-year-old woman with SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome presented with recurrent episodes of pneumonia. She was treated with multiple courses of antibiotics with no success. The transbronchial biopsy undertaken via bronchoscopy revealed organising pneumonia (OP). She was treated with steroids and responded well with full clinical recovery and normalisation of her chest X-ray.To our knowledge, this is the first reported case of OP in association with SAPHO syndrome. This case report highlights the importance of considering OP in patients with SAPHO syndrome who present with chest infection.
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Affiliation(s)
- Fawad Hameed
- Department of Respiratory Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Henry Steer
- Department of Respiratory Medicine, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
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Steer H, Hutton J, Graham S, Jones R. P186 Chest Drain Care Bundle improves Chest Drain Insertion in District General Hospital. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
In response to a recently published article by Messal et al. (2011) in which the authors show that PD-L2 is expressed by activated T cells and ligation results in suppression of T cell proliferation and cytokine secretion, we here report that PD-L2 is differentially expressed by the diverse Th subsets, with predominant expression by Th2 cells.
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Barratt S, Steer H, Onyirioha T. Pneumothorax following acupuncture. Br J Hosp Med (Lond) 2007; 68:677. [PMID: 18186410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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11
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Steer H. Cyclophosphamide in scleroderma lung disease. Thorax 2006. [DOI: 10.1136/thx.2006.la0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- A S Rai
- Southampton General Hospital
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Mitchell A, Steer H, Kettlewell MG. Late appearance of pneumothorax after subclavian vein catheterisation. Br Med J (Clin Res Ed) 1981; 282:822. [PMID: 6783188 PMCID: PMC1504648 DOI: 10.1136/bmj.282.6266.822-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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15
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Ravens KG, Steer H, Wronski R, Pape C. [Transitory myocardial damage by chlorinated hydrocarbons (author's transl)]. Dtsch Med Wochenschr 1974; 99:1364-8. [PMID: 4836073 DOI: 10.1055/s-0028-1107948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Schlaak M, Steer H, Müller-Hermelink HK, Gundermann KO, Bernhard A, Schaefer J. [Fungal endocarditis following implantation of prosthetic heart valves]. Dtsch Med Wochenschr 1973; 98:201-5. [PMID: 4734317 DOI: 10.1055/s-0028-1106777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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