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Rachid C, Ijim M, Fikri O, Amro L. Pulmonary Manifestation of Granulomatosis With Polyangiitis: A Challenging Case Presentation. Cureus 2024; 16:e57515. [PMID: 38707101 PMCID: PMC11067564 DOI: 10.7759/cureus.57515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare and potentially life-threatening autoimmune disease characterized by antineutrophil cytoplasmic antibody (ANCA)-associated vasculature inflammation. It presents as a systemic autoimmune disease with necrotizing granulomatous inflammation and pauci-immune small vessel vasculitis. This case initially posed a diagnostic challenge due to its atypical presentation and was misdiagnosed as hypersensitivity pneumonitis. The avian precipitin screening assay was positive in our patient, which may be consistent with bird breeder's lung disease or a non-specific reactivity of the chicken antigen test. However, the presence of positive c-ANCA was pivotal for the GPA diagnosis. Here, we describe in detail the clinical manifestations, diagnostic approach, and treatment of GPA in a 54-year-old female who presented with alveolar hemorrhage, but no renal involvement. Treatment involved the use of high-dose corticosteroids to suppress the autoimmune response. Finally, we discuss the striking response of this unique form of granulomatosis with polyangiitis to corticosteroid treatment and emphasize the importance of early initiation of treatment.
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Affiliation(s)
- Chaynez Rachid
- Pulmonology Department, Laboratoire de Recherche Morpho Sciences, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Centre Hospitalier Universitaire (CHU) Mohammed VI, Hôpital Arrazi, Marrakech, MAR
| | - Mohamed Ijim
- Pulmonology Department, Laboratoire de Recherche Morpho Sciences, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Centre Hospitalier Universitaire (CHU) Mohammed VI, Hôpital Arrazi, Marrakech, MAR
| | - Oussama Fikri
- Pulmonology Department, Laboratoire de Recherche Morpho Sciences, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Centre Hospitalier Universitaire (CHU) Mohammed VI, Hôpital Arrazi, Marrakech, MAR
| | - Lamyae Amro
- Pulmonology Department, Laboratoire de Recherche Morpho Sciences, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Centre Hospitalier Universitaire (CHU) Mohammed VI, Hôpital Arrazi, Marrakech, MAR
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Buddhavarapu VS, Dhillon G, Grewal H, Kashyap R. Cryptogenic Organizing Pneumonia and Idiopathic Eosinophilic Pneumonia: A Case Report of Clinically Identical Entities. Cureus 2023; 15:e40591. [PMID: 37469815 PMCID: PMC10353704 DOI: 10.7759/cureus.40591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/21/2023] Open
Abstract
Cryptogenic organizing pneumonia (COP) and idiopathic eosinophilic pneumonia (IEP) are two forms of diffuse interstitial lung diseases (ILD) that lead to a rapid respiratory decline in young patients. Both conditions presented with similar clinical and radiological findings, making a clinical diagnosis challenging. They are both considered diagnoses of exclusion, and the treatment for both conditions is high-dose corticosteroids, leading to a quick recovery. Pathological specimens are often required prior to initiating appropriate treatment, leading to significant delays in appropriate therapy and a poorer prognosis. In this case report, we suggest that clinical pearls can be used to establish either diagnosis earlier, which leads to earlier treatment and better outcomes. Our patient presented with an acute respiratory distress syndrome (ARDS) picture, bilateral interstitial infiltrates with peripheral predominance, eosinophilia, and a negative initial infectious and cardiac workup. Based on these findings, we had a high initial suspicion that either COP or IEP was present. Our patient had a bronchoscopy done and was promptly started on steroid therapy soon after, which led to rapid clinical improvement. Pathological specimens were inconclusive, but the patient continued to improve, thereby confirming the presence of either form of ILD. The patient was subsequently discharged home with oxygen and recommended to follow up with a pulmonologist for further outpatient testing and management.
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Affiliation(s)
| | - Gagandeep Dhillon
- Internal Medicine, University of Maryland Baltimore Washington Medical Center (UM BWMC), Glen Burnie, USA
| | - Harpreet Grewal
- Radiology, Florida State University College of Medicine, Pensacola, USA
| | - Rahul Kashyap
- Medicine, Drexel University College of Medicine, Philadelphia, USA
- Medicine, Global Clinical Scholars Research Training (GCSRT) Program, Harvard Medical School, Boston, MA, USA
- Research, Global Remote Research Program, St Paul, USA
- Critical Care Medicine, Mayo Clinic, Rochester, USA
- Research, WellSpan Health, York, USA
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Hamouda S, Ouerfelli R, Trabelsi I, Mrad K, Khalsi F, Boussetta K. A case report of inherited surfactant protein deficiency: unknown cause of diffuse infiltrative diseases in Tunisia. Tunis Med 2022; 100:652-5. [PMID: 36571734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Children's Interstitial Lung Diseases (cHILD) are a heterogeneous group of rare respiratory diseases. Their common characteristics are gas exchange abnormalities and diffuse pulmonary infiltrates on chest imaging. This group includes inherited surfactant protein deficiency (ISPD), a little-known etiology in Tunisia. CASE PRESENTATION A 22-month-old boy was referred to investigate recurrent respiratory infections. He had polypnea, cyanosis, finger clubbing, pectus carinatum, intercostal retraction, and bilateral crackles on pulmonary auscultation. The chest imaging revealed a diffuse ground-glass appearance consistent with cHILD. Lung biopsy was suggestive of ISPD. The infant was mainly treated with intravenous corticosteroids. At the age of nine, he was still dependent on oxygen but had better exercise tolerance. CONCLUSION This case showed that recurrent respiratory infections can hide cHILD which may be related to ISPD, particularly in infants. A better knowledge of this disease was necessary to start specific treatment. Early management would lead to better prognosis.
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Broască L, Trușculescu AA, Ancușa VM, Ciocârlie H, Oancea CI, Stoicescu ER, Manolescu DL. A Novel Method for Lung Image Processing Using Complex Networks. Tomography 2022; 8:1928-1946. [PMID: 35894027 PMCID: PMC9332806 DOI: 10.3390/tomography8040162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 02/07/2023]
Abstract
The High-Resolution Computed Tomography (HRCT) detection and diagnosis of diffuse lung disease is primarily based on the recognition of a limited number of specific abnormal findings, pattern combinations or their distributions, as well as anamnesis and clinical information. Since texture recognition has a very high accuracy percentage if a complex network approach is used, this paper aims to implement such a technique customized for diffuse interstitial lung diseases (DILD). The proposed procedure translates HRCT lung imaging into complex networks by taking samples containing a secondary lobule, converting them into complex networks and analyzing them in three dimensions: emphysema, ground glass opacity, and consolidation. This method was evaluated on a 60-patient lot and the results showed a clear, quantifiable difference between healthy and affected lungs. By deconstructing the image on three pathological axes, the method offers an objective way to quantify DILD details which, so far, have only been analyzed subjectively.
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Affiliation(s)
- Laura Broască
- Department of Computer and Information Technology, Automation and Computers Faculty, “Politehnica” University of Timișoara, Vasile Pârvan Blvd. No. 2, 300223 Timișoara, Romania; (L.B.); (V.M.A.); (H.C.)
| | - Ana Adriana Trușculescu
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timișoara, Romania;
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’, University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Correspondence:
| | - Versavia Maria Ancușa
- Department of Computer and Information Technology, Automation and Computers Faculty, “Politehnica” University of Timișoara, Vasile Pârvan Blvd. No. 2, 300223 Timișoara, Romania; (L.B.); (V.M.A.); (H.C.)
| | - Horia Ciocârlie
- Department of Computer and Information Technology, Automation and Computers Faculty, “Politehnica” University of Timișoara, Vasile Pârvan Blvd. No. 2, 300223 Timișoara, Romania; (L.B.); (V.M.A.); (H.C.)
| | - Cristian-Iulian Oancea
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timișoara, Romania;
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’, University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Emil-Robert Stoicescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania;
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania
| | - Diana Luminița Manolescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’, University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania;
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Hasegawa M, Sakai F, Okabayashi A, Katsura H, Kamata T, Koh E, Sekine Y, Takemura T, Nakatani Y, Hiroshima K. Rosai-Dorfman Disease of the Lung Overlapping with IgG4-related Disease: The Difficulty in Its Differential Diagnosis. Intern Med 2017; 56:937-941. [PMID: 28420843 PMCID: PMC5465411 DOI: 10.2169/internalmedicine.56.7609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We herein report a case of Rosai-Dorfman disease (RDD) overlapping with IgG4-related disease (IgG4-RD), which presented as diffuse interstitial lung disease with a perilymphatic pattern, followed by submandibular gland and eyelid swelling. The pathological findings of the submandibular gland biopsy specimen were indicative of IgG4-RD alone. We diagnosed the patient with RDD with overlapping IgG4-RD. However, the optimal method for differentiating between these two entities is still controversial. It is important that clinicians are aware that RDD should be included in the differential diagnoses of diffuse interstitial lung disease with a perilymphatic pattern and that RDD can overlap with IgG4-RD.
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Affiliation(s)
- Mizue Hasegawa
- Division of Respiratory Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Japan
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Japan
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Japan
| | - Asako Okabayashi
- Division of Respiratory Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | - Hideki Katsura
- Division of Respiratory Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | - Toshiko Kamata
- Division of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | - Eitetsu Koh
- Division of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | - Yasuo Sekine
- Division of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, Japan
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Japan
| | - Kenzo Hiroshima
- Division of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Japan
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Popper HH. Interstitial lung diseases-can pathologists arrive at an etiology-based diagnosis? A critical update. Virchows Arch 2013; 462:1-26. [PMID: 23224047 PMCID: PMC7102182 DOI: 10.1007/s00428-012-1305-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 08/13/2012] [Accepted: 08/17/2012] [Indexed: 01/07/2023]
Abstract
Interstitial lung diseases (ILD) encompass a group of diseases with a wide range of etiologies and a variety of tissue reactions within the lung. In many instances, a careful evaluation of the tissue reactions will result in a specific diagnosis or at least in a narrow range of differentials, which will assist the clinician to arrive at a definite diagnosis, when combining our interpretation with the clinical presentation of the patient and high-resolution computed tomography. In this review, we will exclude granulomatous pneumonias as well as vascular diseases (primary arterial pulmonary hypertension and vasculitis); however, pulmonary hypertension as a complication of interstitial processes will be mentioned. Few entities of pneumoconiosis presenting as an interstitial process will be included, whereas those with granulomatous reactions will be excluded. Drug reactions will be touched on within interstitial pneumonias, but will not be a major focus. In contrast to the present-day preferred descriptive pattern recognition, it is the author's strong belief that pathologists should always try to dig out the etiology from a tissue specimen and not being satisfied with just a pattern description. It is the difference of sorting tissue reactions into boxes by their main pattern, without recognizing minor or minute reactions, which sometimes will guide one to the correct etiology-oriented interpretation. In the author's personal perspective, tissue reactions can even be sorted by their timeliness, and therefore, ordered by the time of appearance, providing an insight into the pathogenesis and course of a disease. Also, underlying immune mechanisms will be discussed briefly as far as they are essential to understand the disease.
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Affiliation(s)
- Helmut H Popper
- Research Unit for Molecular Lung and Pleura Pathology, Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, Graz, 8036, Austria.
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