Organizing Pneumonia

机化性肺炎
  • 文章类型: Case Reports
    Brentuximabvedotin(BV)是一种抗CD30抗体,已被批准用于各种癌症,包括难治性霍奇金淋巴瘤(HL),间变性大细胞淋巴瘤(ALCL)等。总的来说,已发现BV具有良好的耐受性,最常见的副作用是周围神经病变和中性粒细胞减少。BV诱导的肺炎极为罕见。据我们所知,这是第六例报道的BV诱导的肺毒性。
    该病例介绍了一名四十多岁的女性患者,诊断为皮肤T细胞淋巴瘤,正在接受BV治疗。她出现了急性低氧性呼吸衰竭,最终,接受了包括计算机断层扫描(CT)扫描在内的诊断评估,这显示了双边空域巩固和毛玻璃不透明,提示机化性肺炎和弥漫性肺泡损伤。支气管镜支气管肺泡灌洗和经支气管活检排除了感染,和肺淋巴瘤,并证实诊断为BV诱导的肺炎。患者在停用违例药物后有明显的临床改善,开始使用类固醇,在8周随访时具有最佳的临床恢复。
    药物相关性肺炎在癌症患者的治疗中引起了极大的关注。众多的化疗药物,比如博来霉素,环磷酰胺,甲氨蝶呤,沙利度胺,和其他人,与肺部相关的毒性。这些不良反应主要源于直接毒性或免疫抑制相关感染。不太常见,可能发生免疫介导的损伤。
    医生必须高度怀疑BV引起的肺炎,因此,早期识别,随后持有病原体,用类固醇开始免疫抑制,偶尔还有保留类固醇的药物,防止其他致命的结果。
    UNASSIGNED: Brentuximab vedotin (BV) is an anti-CD30 antibody approved for various cancers, including refractory Hodgkin lymphoma (HL), anaplastic large-cell lymphoma (ALCL) among others. In general, BV has been found to be well-tolerated, with the most frequently reported side effects being peripheral neuropathy and neutropenia. BV-induced pneumonitis is extremely rare. To the best of our knowledge, this is the sixth reported instance of BV-induced lung toxicity.
    UNASSIGNED: This case presents a female patient in her forties diagnosed with cutaneous T-cell lymphoma undergoing BV treatment. She developed acute hypoxic respiratory failure, ultimately, underwent a diagnostic evaluation including a computed tomography (CT) scan, which showed bilateral airspace consolidations and ground-glass opacities, suggestive of organizing pneumonia and diffuse alveolar damage. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy ruled out infection, and pulmonary lymphoma and confirmed the diagnosis of BV-induced pneumonitis. The patient had significant clinical improvement after stopping the offending agent, and starting steroids, with optimal clinical recovery at 8 weeks follow-up.
    UNASSIGNED: Drug-related pneumonitis poses a significant concern in the management of cancer patients. Numerous chemotherapeutic agents, such as bleomycin, cyclophosphamide, methotrexate, thalidomide, and others, have been associated with pulmonary-related toxicities. These adverse effects primarily stem from direct toxicity or immunosuppression-related infections. Less commonly, immune-mediated injury may occur.
    UNASSIGNED: Physicians must have a high index of suspicion for BV-induced pneumonitis, hence, early recognition with subsequent holding of the causative agent, initiation of immunosuppression with steroids, and occasionally steroid-sparing medications, prevent an otherwise fatal outcome.
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  • 文章类型: Journal Article
    UNASSIGNED: Regardless corticosteroids are recommended for the treatment of organizing pneumonia there is limited evidence supporting this practice. Thus, we performed a systematic review of the literature on systemic corticosteroid treatment for organizing pneumonia.
    UNASSIGNED: A search was implemented in the PubMed database (Medline) for articles published in the last 20 years. Those studies with incomplete or insufficient data and case reports were excluded. We collected data including: demographics, clinical data, diagnostic procedures, aetiology, treatment regimen (drug, posology, duration, response) and evolution.
    UNASSIGNED: A total of 135 publications were selected and finally 13 studies with 849 patients were included in the review: 12 retrospective observational studies and a single prospective observational study. Most of the patients were started on treatment with systemic corticosteroids - a total of 627 (30-100% depending on the series), but there was a great heterogeneity regarding drug, doses and duration. On those that started treatment, 226 (36%) presented a relapse of the disease during follow-up. Only one study provided information regarding treatment side-effects.
    UNASSIGNED: The findings of this systematic review show the low quality data supporting the use of corticosteroids for the treatment of organizing pneumonia. This highlights a need to undertake appropriately designed studies to investigate which is the most appropriate treatment regimen that trades off benefits and risks of prolonged corticosteroid administration.
    UNASSIGNED: Aunque los corticosteroides están recomendados para tratar la neumonía organizada, hay pocos datos que respalden esta práctica, por lo cual efectuamos una revisión sistemática de la bibliografía sobre el tratamiento con corticosteroides sistémicos para la neumonía organizada.
    UNASSIGNED: Se hizo una búsqueda en la base de datos PubMed (Medline) de artículos publicados en los últimos 20 años. Se descartaron los estudios con datos y casos clínicos incompletos o insuficientes. Los datos que recabamos abarcaron: datos demográficos, datos clínicos, técnicas diagnósticas, etiología, pauta terapéutica (fármaco, posología, duración, respuesta) y evolución.
    UNASSIGNED: Se eligieron 135 publicaciones en total y se incorporaron finalmente a la revisión 13 estudios con 849 pacientes: 12 estudios observacionales retrospectivos y un solo estudio observacional prospectivo. La mayor parte de los pacientes habían comenzado el tratamiento con corticosteroides sistémicos, un total de 627 (30%-100% en función de la serie), pero la duración, las dosis y el fármaco manifestaron una gran heterogeneidad. Entre los que habían empezado el tratamiento, 226 (36%) presentaron una recidiva de la enfermedad durante el seguimiento. Solo en un estudio se ofreció información sobre los efectos adversos del tratamiento.
    UNASSIGNED: Los resultados de esta revisión ponen de manifiesto la escasa calidad de los datos sobre el tratamiento de la neumonía organizada con corticosteroides. Este hecho destaca la necesidad de emprender estudios diseñados correctamente para investigar la pauta terapéutica más adecuada que compense los riesgos y beneficios de la administración prolongada de corticosteroides.
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  • 文章类型: Review
    背景:机化性肺炎(OP)是一种罕见的间质性肺病。由结核分枝杆菌(MTB)引起的继发性机化性肺炎(SOP)极为罕见。迁移MTB相关的SOP更具欺骗性和危险性。当隐匿性结核病(TB)不被识别时,SOP会被误诊为隐源性机化性肺炎(COP)。单独使用类固醇激素会导致结核病灶的进展甚至死亡。迫切需要在OP背景下区分非典型结核病的线索。
    方法:一名56岁女性患者因咳嗽、咳痰等原因住院超过半个月。她的病史和家族史显示与结核病或其他肺部疾病无关。诊断为社区获得性肺炎,开始抗感染治疗,但无效。患者持续失重。更令人费解的是,根据胸部计算机断层扫描(CT)图像,病变为可迁移的.患者随后被转移到我们医院。血液中感染的免疫学指标及痰液和支气管肺泡灌洗液的病原学检测均为阴性。经皮肺穿刺活检病理观察证实OP,但没有肉芽肿性病变.此外,通过宏基因组学下一代测序测试(mNGS)对穿刺肺组织的病原体检测均为阴性。COP被高度怀疑。幸运的是,靶向下一代测序(tNGS)在穿刺肺组织中检测到MTB,并明确诊断出MTB相关SOP.给予抗结核和泼尼松联合治疗。治疗10天后,部分病变被明显吸收,患者出院。在半年的随访中,病人是健康的。
    结论:在临床实践中很难区分SOP和COP。COP的诊断必须非常谨慎。早期肺部图像中的短暂小结节和空洞是考虑结核病的线索,即使所有病原体测试都是阴性的。tNGS也是检测病原体的强大工具,确保及时诊断结核病相关的SOP。对于结核病高负担国家的临床医生来说,我们鼓励他们在最终诊断COP之前牢记结核病。
    BACKGROUND: Organizing pneumonia (OP) is a rare interstitial lung disease. Secondary organizing pneumonia (SOP) caused by Mycobacterium tuberculosis (MTB) is extremely rare. Migratory MTB-associated SOP is more deceptive and dangerous. When insidious tuberculosis (TB) is not recognized, SOP would be misdiagnosed as cryptogenic organizing pneumonia (COP). Use of steroid hormone alone leads to the progression of TB foci or even death. Clues of distinguishing atypical TB at the background of OP is urgently needed.
    METHODS: A 56-year-old female patient was hospitalized into the local hospital because of cough and expectoration for more than half a month. Her medical history and family history showed no relation to TB or other lung diseases. Community-acquired pneumonia was diagnosed and anti-infection therapy was initialized but invalid. The patient suffered from continuous weigh loss. More puzzling, the lesions were migratory based on the chest computed tomography (CT) images. The patient was then transferred to our hospital. The immunological indexes of infection in blood and pathogenic tests in sputum and the bronchoalveolar lavage fluid were negative. The percutaneous lung puncture biopsy and pathological observation confirmed OP, but without granulomatous lesions. Additionally, pathogen detection of the punctured lung tissues by metagenomics next generation sequencing test (mNGS) were all negative. COP was highly suspected. Fortunately, the targeted next-generation sequencing (tNGS) detected MTB in the punctured lung tissues and MTB-associated SOP was definitely diagnosed. The combined therapy of anti-TB and prednisone was administrated. After treatment for 10 days, the partial lesions were significantly resorbed and the patient was discharged. In the follow-up of half a year, the patient was healthy.
    CONCLUSIONS: It is difficult to distinguish SOP from COP in clinical practice. Diagnosis of COP must be very cautious. Transient small nodules and cavities in the early lung image are a clue to consider TB, even though all pathogen tests are negative. tNGS is also a powerful tool to detect pathogen, ensuring prompt diagnosis of TB-related SOP. For clinicians in TB high burden countries, we encourage them to keep TB in mind before making a final diagnosis of COP.
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  • 文章类型: Review
    X连锁无丙种球蛋白血症(XLA)是一种原发性免疫缺陷,其特征是血清免疫球蛋白和早发性感染显着减少。免疫功能低下患者的冠状病毒病-2019(COVID-19)肺炎呈现临床和放射学特性,尚未完全了解。自2020年2月大流行开始以来,报告的COVID-19无球蛋白血症患者病例很少。我们报告了两例XLA患者的移民COVID-19肺炎。
    X-linked agammaglobulinemia (XLA) is a primary immunodeficiency characterized by marked reduction in serum immunoglobulins and early-onset infections. Coronavirus Disease-2019 (COVID-19) pneumonia in immunocompromised patients presents clinical and radiological peculiarities which have not yet been completely understood. Very few cases of agammaglobulinemic patients with COVID-19 have been reported since the beginning of the pandemic in February 2020. We report two cases of migrant COVID-19 pneumonia in XLA patients.
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  • 文章类型: Case Reports
    背景:急性纤维性和机化性肺炎(AFOP)是一种罕见的组织学间质性肺炎,其特征是肺泡内分布的“纤维蛋白球”斑块和机化性肺炎。目前,对这种疾病的诊断和治疗尚无共识。
    方法:我们介绍一例44岁男性继发于结核分枝杆菌的AFOP。我们进一步回顾了由结核病引起的机化性肺炎(OP)和AFOP。
    结论:继发于OP或AFOP的结核病是罕见且具有挑战性的诊断。我们需要根据患者的症状不断调整治疗方案,测试结果,和对治疗的反应,以达到准确的诊断并最大限度地提高治疗效果。
    BACKGROUND: Acute fibrinous and organizing pneumonia (AFOP) is a rare histological interstitial pneumonia pattern characterized by patches of \"fibrin balls\" distributed within the alveoli and organizing pneumonia. Currently, there is no consensus on the diagnosis and treatment of this disease.
    METHODS: We present the case of a 44-year-old male with AFOP secondary to Mycobacterium tuberculosis. We have further reviewed organizing pneumonia (OP) and AFOP caused by tuberculosis.
    CONCLUSIONS: Tuberculosis secondary to OP or AFOP is rare and challenging to diagnose. We need to constantly adjust the treatment plan based on the patient\'s symptoms, test results, and response to treatment in order to arrive at an accurate diagnosis and maximize treatment efficacy.
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  • UNASSIGNED:机化性肺炎是一种临床和病理综合征,描述了由肺泡结缔组织中的炎症反应引起的肺损伤。分类为间质性肺病,它可以继发于感染,药物毒性,结缔组织疾病,吸入性损伤(可卡因),器官移植,或放射治疗,也可能是特发性的。虽然机化肺炎并不是一个新现象,已注意到这是COVID-19的并发症,应在患有COVID-19且胸部影像学不典型的患者中考虑,因为治疗包括皮质类固醇而不是抗生素。
    UNASSIGNED: Organizing pneumonia is a clinical and pathological syndrome that describes a lung injury caused by an inflammatory reaction in the alveolar connective tissue. Classified as an interstitial lung disease, it can be secondary to infection, drug toxicity, connective tissue disorders, inhalation injuries (cocaine), organ transplant, or radiotherapy, and also can be idiopathic. Although organizing pneumonia is not a new phenomenon, it has been noted to be a complication of COVID-19, and should be considered in patients who have had COVID-19 and have atypical chest imaging, because treatment includes corticosteroids instead of antimicrobials.
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  • 文章类型: Case Reports
    COVID-19的晚期后果是机化性肺炎,其特征是明显的影像学和病理异常。这项研究的目标是更好地理解这些异常。使用皮质激素仍然是COVID-19的推荐治疗方案。另一方面,目前尚不清楚皮质激素对COVID-19后机化性肺炎是否有相同的影响。一名53岁的男性患者在感染COVID-19后被确定为有组织的肺炎。他在经历了严重的呼吸道症状几天后被诊断为没有改善。根据影像学和病理结果,我们开始了高剂量的皮质激素,并观察到了显着的反应。此外,我们研究了有关这种特殊疾病的诊断和治疗的研究。新冠肺炎后被诊断为肺炎的患者需要接受包括胸部CT扫描在内的重新评估,这些患者中的一些可能是早期肺活检的候选人。对于COVID-19引起的机化性肺炎,最有效和令人信服的治疗是皮质激素治疗,剂量相当于泼尼松0.5mg/kg/天。
    A late consequence of COVID-19, organizing pneumonia is characterized by significant imaging and pathological abnormalities. The goals of this study are to better understand these abnormalities. The use of corticoid continues to be the recommended course of treatment for COVID-19. On the other hand, it is not clear whether or not corticoid has the same impact on organizing pneumonia after COVID-19. A 53-year-old male patient was identified with organized pneumonia following COVID-19 infection. He was diagnosed after experiencing severe respiratory symptoms several days with no improvement. We initiated a high dose of corticoid based on imaging and pathological findings and observed a significant response. In addition, we looked into the research that has been done concerning the diagnosis and treatment of this peculiar ailment. Patients who have been diagnosed with pneumonia after COVID 19 are required to undergo a reevaluation that includes a chest CT scan, and some of these patients may be candidates for an early lung biopsy. The most effective and convincing therapy for COVID-19-induced organizing pneumonia is corticoid treatment at a dose equivalent to 0.5 mg/kg/day of prednisone.
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  • 文章类型: Case Reports
    一名肺炎患者发烧2周。最初的抗感染治疗失败后,他被诊断出患有C.pittaci肺炎并伴有机化性肺炎,通过支气管肺泡灌洗液(BALF)的下一代测序(mNGS)和肺活检。他接受了抗生素和皮质类固醇治疗2个月。
    A patient with pneumonia had a fever for 2 weeks. After the initial anti-infection treatment failed, he was diagnosed with C. psittaci pneumonia complicated with organizing pneumonia, through next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) and lung biopsy. He was treated with antibiotics and corticosteroids for 2 months.
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  • 文章类型: Case Reports
    机化性肺炎(OP)是一种弥漫性间质性肺病,这可能是在几种临床情况下诱发的,如药物反应,感染,自身免疫性疾病和癌症。据报道,2019年冠状病毒病(COVID-19)相关的OP是COVID-19相关肺炎感染或组织学形式的晚期结果。尸体解剖和死后肺活检表明,大多数COVID-19相关性肺炎患者会发生继发性OP,COVID-19相关性肺炎和OP具有共同的放射学特征。严重急性呼吸综合征冠状病毒2感染患者应怀疑COVID-19相关OP的诊断,尽管采取了最佳护理,但其临床症状恶化,或最初恢复后症状加重的人。使用皮质类固醇是OP的典型治疗方法。然而,到目前为止,至少就我们所知,有一些关于糖皮质激素在COVID-19相关肺炎中的作用的报道;因此,最佳管理时间,剂量和治疗持续时间尚未确定.本研究提供了2例COVID-19患者,他们在感染初期表现出临床恶化,并具有OP的放射学特征,他们接受了皮质类固醇并获得了良好的预后。COVID-19相关OP的早期诊断可能导致靶向治疗,对通气支持的需求降低,存活率提高。
    Organizing pneumonia (OP) is a type of diffuse interstitial lung disease, which may be induced in the context of several clinical conditions, such as drug reactions, infections, autoimmune diseases and cancer. Coronavirus disease 2019 (COVID-19)-associated OP has been reported as a late-stage consequence of the infection or a histological form of COVID-19-associated pneumonia. Autopsies and postmortem lung biopsies have demonstrated that the majority of patients with COVID-19-associated pneumonia develop secondary OP, and COVID-19-associated pneumonia and OP have common radiological features. The diagnosis of COVID-19-associated OP should be suspected in patients with severe acute respiratory syndrome coronavirus 2 infection who exhibit clinical deterioration despite optimal care, or who have aggravating symptoms following an initial recovery. The use of corticosteroids is a typical treatment for OP. However, to date, at least to the best of our knowledge, there are a few reports regarding the role of corticosteroids in COVID-19-associated pneumonia; thus, the optimal time for administration, the dose and treatment duration have not yet been determined. The present study presents two cases of patients with COVID-19, who exhibited clinical deterioration following the initial phase of infection and with radiological characteristics of OP who received corticosteroids and had a favorable outcome. The early diagnosis of COVID-19-associated OP may lead to targeted treatment, decreased requirements for ventilatory support and an improved survival rate.
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  • 文章类型: Journal Article
    背景:机化性肺炎(OP)是系统性红斑狼疮(SLE)的罕见表现。在极少数病例报告中对此进行了描述。目的和方法:我们在1年内在3例SLE患者中发现了OP;其中2例表现为SLE的初始表现,而第三个表现为OP时,SLE复发。阐明SLE患者OP的临床特征和转归,我们在PubMed数据库中筛选了在SLE诊断时或诊断后诊断为OP的病例;搜索仅限于1990年后发表的文章,那时OP被广泛认可.结果:我们在SLE患者中确定了15例OP。因此,我们共分析了18例(包括我们的3例)。15例SLE初次诊断时发生OP,3例SLE复发时发生OP。在大多数情况下,SLE的疾病活动度为中度或高度。在所有情况下,OP伴有SLE的其他肺外症状,即,发烧(77.8%),皮肤表现(61.1%),关节痛/关节炎(50%),和狼疮性肾炎(33.3%)。类固醇单药治疗或增加剂量的类固醇是有效的7例(38.8%);然而,类固醇单药治疗无效,2例(11.1%)因呼吸衰竭导致死亡.类固醇与羟氯喹的联合治疗,硫唑嘌呤,他克莫司,霉酚酸酯,静脉脉冲环磷酰胺治疗,和贝利木单抗在7例(38.8%)中有效。结论:根据对以前报道的病例和我们的病例的回顾,结论OP是SLE的重要肺部表现。临床医生应该意识到这一点,因为在诊断SLE时或之后可能需要强化免疫抑制治疗。
    Background: Organizing pneumonia (OP) is a rare manifestation of systemic lupus erythematosus (SLE). It has been described in very few case reports.Purpose and Methods: We encountered OP in three patients with SLE in 1 year; two manifested OP as an initial presentation of SLE, while the third manifested OP when SLE relapsed. To elucidate the clinical features and outcomes of OP in patients with SLE, we screened the PubMed database for cases diagnosed with OP either at or after the diagnosis of SLE; the search was restricted to articles that were published after 1990, when OP became widely recognized.Results: We identified 15 cases of OP in patients with SLE. Thus, we analyzed a total of 18 cases (including our three). OP developed at the initial diagnosis of SLE in 15 cases and at relapse of SLE in three cases. In most cases, the disease activity of SLE was moderate or high. In all cases, OP was accompanied by other extrapulmonary symptoms of SLE, namely, fever (77.8%), cutaneous manifestations (61.1%), arthralgia/arthritis (50%), and lupus nephritis (33.3%). Steroid monotherapy or increasing the dose of the steroids was effective in seven cases (38.8%); however, steroid monotherapy was ineffective and led to death due to respiratory failure in two cases (11.1%). Combination therapies of steroids with hydroxychloroquine, azathioprine, tacrolimus, mycophenolate mofetil, intravenous pulse cyclophosphamide therapy, and belimumab were effective in seven cases (38.8%).Conclusions: Based on the review of previously reported and our cases, we concluded that OP is an important pulmonary manifestation of SLE. Clinicians should be aware of it as it may require intensive immunosuppressive therapy either at or after the diagnosis of SLE.
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