Recurrent flu-like illness with migrating pulmonary infiltrates of unknown aetiology

Abstract

Migrating pulmonary infiltrates present a difficult diagnostic and therapeutic challenge. We report on eight patients (mean age 51 years, range 32-78 years, with a prolonged history of migrating pulmonary infiltrates of unknown aetiology despite a very elaborate search for infectious causes, hypersensitivity pneumonitis or inhalation fever due to occupational or domestic exposure to fungi, or to other environmental causes, and for humoral or cellular immunological incompetence. These patients (one male, seven females) presented with recurrent episodes (mean 6, range 2-13) of a flu-like illness, often with cough, wheezing and pleuritic chest pain, but without systemic involvement. Previous medical histories were unremarkable. There was no relation with smoking habits, occupation, drug use or other possible exposures. Biochemical data were non-specific. There was no peripheral nor pulmonary eosinophilia; total IgE was normal, with negative RASTs and precipitins to a variety of antigens. Cultures and serological tests for bacteria, viruses, fungi, etc were non-contributory. Chest X-ray and computed tomography (CT) scan showed bilateral migratory pulmonary infiltrates, with a predilection for the middle and lower lung zones, often with a minor-to-moderate pleural effusion. Lung function tests were usually normal; at the most a slight decrease in diffusing capacity was noted in some patients. There was no or only a slight response to antimicrobials; systemic corticosteroids were not given. Further evolution was benign with patients being asymptomatic between the episodes. Despite elaborate investigations, the cause of these 'pneumonias' remains frustratingly unknown.

Natural history of Mycobacterium fortuitum pulmonary infection presenting with migratory infiltrates: a case report with microbiological analysis

“…In a previous study, the CT findings of M. fortuitum pulmonary infection demonstrated various lesions, including bronchiectasis, nodules, consolidation, and cavity lesions [ 8 ]; however, the longitudinal changes without antimicrobial therapy have not been reported. Various pulmonary diseases such as cryptogenic organizing pneumonia, chronic eosinophilic pneumonia, hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis, lymphoproliferative disorder, vasculitis, and aspiration pneumonitis can cause migratory infiltrates [ 17 – 20 ]. Furthermore, gastroesophageal reflux can introduce pulmonary infiltrates, leading to aspiration pneumonitis [ 21 ].…”

Cryptogenic Organizing Pneumonia

“…Migratory opacities occur in 25% to 50% of cases 17,21 and provide an important clue to the diagnosis of COP, since the differential diagnosis is relatively narrow ( Table 1). [35][36][37][38] Comparison of A with B shows appearance of a consolidation of the right upper lobe. Comparison of C with D shows spontaneous resolution of a subpleural consolidation of the right lower lobe, and the appearance of new opacities in the same lobe and in subpleural areas of the left lung.…”

Επίδραση Του Επαγγελματικού Περιβάλλοντος Στους Πνεύμονες Οδοντοτεχνιτών

“…Επηρεάζουν τη τάση για µετανάστευση. Όσο αφορά την σειρά ευκολίας που οι ίνες των διαφόρων µορφών αµιάντου φθάνουν στον υπεζωκότα, µετά την εναπόθεσή τους στις κυψελίδες, οι βελονόµορφες οξείες [44][45][46][47] πνευµονίτιδας από υπεραυαισθησία, [48][49][50] βηρυλλίωσης, [51][52][53][54][55] παθήσεων του αναπνευστικού από εισπνοή σκληρών µετάλλων, 56,57 πιθανόν των παθολογοανατοµικών εκδηλώσεων της πυριτίασης. 58 Προτάθηκε πως ο ιστικός τύπος, ως καθορίσθηκε µε την HLA δοκιµασία, είναι σοβαρός παράγοντας στο να προβλέψουµε την ανάπτυξη µερικών παθήσεων όπως λόγου χάρη η αµιάντωση και η πνευµονοκονίωση των ανθρακωρύχων.…”