Introduction: Hypersensitivity pneumonitis (HP) is the third most common interstitial lung disease after idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Pathogenesis of HP is related to repeated exposure to inhaled environmental antigens that sensitise the susceptible, genetically predisposed persons. The aim of the present retrospective study was to summarise the diagnostic methods used in consecutive patients with HP, recognised in a single pulmonary unit, between 2005 and 2015, and to compare them with current diagnostic criteria. Material and methods: 135 patients, 68 males, 67 females, median age 53 years (18-75 years), entered the study. Chest CT features characteristic of HP were defined as: mosaic attenuation of lung parenchyma, air trapping and/or ill-defined centrilobular nodules. Lymphocytosis in BAL was defined as ≥ 30%. Results: Median time from first symptoms to diagnosis was 12 months. The exposure to one or more allergens was found in 94% of patients, chest CT features characteristic of HP have been reported in 87%, BAL lymphocytosis -in 86%. According to recent diagnostic criteria -in 54% of patients, clinical diagnosis of HP was confident, in 16% -probable, in 26% -possible and in 4% -unlikely. The confirmation of HP with lung biopsy has been obtained in 36% of non-confident cases (16% of the study group). Conclusion: HP diagnosis was confirmed according to current diagnostic criteria in 70% of patients diagnosed between 2005 and 2015. Contradictions to lung biopsy have been the main reason for inability to confirm HP in non-confident cases.
Introduction:Hypersensitivity pneumonitis (HP) is the third most common interstitial lung disease, and is often under-recognized, especially in patients who are not aware of their occupational or environmental contact with organic antigens. The aim of the present study was to assess the results of serum specific IgG antibodies (ssIgG) in HP patients and their correlation with clinical data.Material and methods: 128 HP patients, median age 53 years, participated in the study. The control group consisted of 102 patients with interstitial lung diseases (ILDs) other than HP. Assessment of pretreatment ssIgG to thermophilic actinomycetes and protein antigens from bird droppings (pigeons, hens, ducks, parrots, turkeys) was performed by double diffusion in agar gel according to Ouchterlony method.Results: Positive precipitins were obtained in 57% of all HP patients and in 61% of those exposed to above mentioned antigens. Positive results in the control group were obtained in 7% of patients. Sensitivity of ssIgG in HP group was 0.57 and specificity 0.93. Precipitins to at least one bird antigen was confirmed in 64% of HP patients exposed to birds. Precipitins to thermophilic bacteria were found in 29% of HP patients exposed to hay or hay products.Conclusions: The results of the study indicate that ssIgG against birds' allergens were the valuable diagnostic tool in HP patients. Low-rate of confirmation of ssIgG to thermophilic bacteria in patients exposed to hay or hay products indicate that other microorganisms, most likely molds, could be responsible for the disease development.
Mycobacterial lung disease is caused by nontuberculous mycobacteria (NTM), also known as atypical mycobacteria. NTM are widely distributed in the environment, particularly in soil and water; they may colonize the airways, gastrointestinal tract and genitourinary system, without the apparent signs of disease. Nevertheless, in some risk groups such as patients with chronic lung diseases or with immunodeficiency, mycobacterial lung disease is identified. Recently, increased recognition of mycobacterial lung disease in chronic obstructive pulmonary disease (COPD) patients has been observed, especially in those treated with high doses of inhaled corticosteroids. In the present paper, we describe the patient treated for many years due to COPD and bronchiectasis, with clinical and radiological picture suggestive of lung tumor, in whom final diagnosis of mycobacterial lung disease caused by Mycobacterium avium was made.
Introduction: The diagnostic algorithm of non-high risk pulmonary embolism (PE) is based on probability scoring systems and plasma D-dimer (DD) assessment. The aim of the present study was to investigate the efficacy of Revised Geneva Scoring (RGS) and DD testing for the excluding of non-high risk PE, in the patients admitted to the hospital due to acute respiratory diseases. Material and methods:The consecutive patients, above 18 years of age, referred to the department of lung diseases, entered the study. The exclusion criteria were: the pregnancy and the suspicion of high risk PE. Plasma DD was measured with quick ELISA test, VIDAS D-dimer New, bioMerieux, France. Multislice computed tomography angiography was performed in all of the patients. Results: 153 patients, median age 65 (19−88) years entered the study. The probability of PE was: low -in 58 patients (38%), intermediate -in 90 (59%), high -in 5 (3%). DD < 500 ng/ml was found in 12% of patients with low and intermediate probability of PE. PE was recognized in 10 out of 153 patients (7%). None of the patients with DD < 500 ng/ml was diagnosed with PE (NPV 100%). Median DD value was significantly higher in PE patients comparing to non-PE (4500 ng/ml and 1356 ng/ml respectively, p = 0.006). Conclusion: In the group of the patients with acute respiratory symptoms, low or intermediate clinical probability scoring combined with normal DD had a high NPV in excluding PE. Nevertheless, such approach was not very effective, as the increased DD was noted in 88% of the examined population.
Leflunomid (LEF), pochodna izoksazolowa, należy do leków przeciwreumatycznych modyfikujących przebieg choroby (DMARDs), które stanowią podstawę leczenia reumatoidalnego zapalenia stawów (RZS). J est lekiem skutecznym i bezpiecznym u chorych na RZS w sytuacji, gdy standardowe leczenie nie spowodowało znaczącej poprawy lub było źle tolerowane, ale może wywoływać śródmiąższową chorobę płuc. Czynnikami ryzyka wystąpienia śródmiąższowej choroby płuc wywołanej LEF są: stwierdzane wcześniej zmiany śródmiąższowe w płucach, palenie papierosów, niska masa ciała i stosowanie dawki nasycającej. W pracy przedstawiono przypadek 59-letniego chorego na RZS, z nikotynizmem w wywiadzie, leczonego w przeszłości metotreksatem (MTX), u którego wystąpiły duszność, kaszel i gorączka po około 2 miesiącach leczenia LEF. Z astosowano metyloprednizolon w pulsach, następnie prednizon i cyklofosfamid. Po okresie przejściowej poprawy doszło do narastania niewydolności oddechowej i zgonu.
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