scholarly journals Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series

2021 ◽  
pp. 101562
Author(s):  
Margaret Kypreos ◽  
Tyonn Barbera ◽  
Chad A. Newton ◽  
Craig S. Glazer ◽  
Traci N. Adams
2021 ◽  
pp. 101498
Author(s):  
Yukihiro Nakamura ◽  
Takayuki Takimoto ◽  
Takehiko Kobayashi ◽  
Kazunobu Tachibana ◽  
Takahiko Kasai ◽  
...  

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-224507
Author(s):  
Marissa O’Callaghan ◽  
Aurelie Fabre ◽  
Michael Keane ◽  
Timothy J McDonnell

Our case series describes two siblings with complex fibrosing lung diseases. The first patient was initially given a diagnosis of sarcoidosis based on imaging and exclusion of alternative diagnoses. A number of years after diagnosis, he had rapid deterioration of his disease and following surgical lung biopsy, his lung fibrosis was re-classified as chronic hypersensitivity pneumonitis (cHP) with a usual interstitial pneumonia pattern. He subsequently underwent successful lung transplantation. The second patient presented with rapidly progressing exertional dyspnoea. His bloods, imaging, bronchoalveolar lavage and histology were discussed at our multidisciplinary team meeting. His histology was most in keeping with subacute on cHP with overlapping imaging features between the two siblings. He was treated accordingly but unfortunately succumbed to his illness shortly after diagnosis. These cases highlight the difficulties differentiating between the various interstitial lung disease (ILD) subtypes and the challenges in management while also increasing awareness of familial ILD.


CHEST Journal ◽  
2012 ◽  
Vol 142 (4) ◽  
pp. 473A
Author(s):  
Lahari Rampur ◽  
Shravan Kooragayalu ◽  
Purvi Parikh ◽  
Sunit Jariwala ◽  
Golda Hudes ◽  
...  

2020 ◽  
Vol 6 (4) ◽  
pp. 00374-2020
Author(s):  
Hayley Barnes ◽  
Anna-Carin Olin ◽  
Kjell Torén ◽  
Charles McSharry ◽  
Iona Donnelly ◽  
...  

BackgroundDespite well-documented case series of hypersensitivity pneumonitis (HP), epidemiological data delineating relative contributions of risk factors are sparse. To address this, we estimated HP risk in a case-referent study of occupational and nonoccupational exposures.MethodsWe recruited cases of HP by ICD-9 codes from an integrated healthcare delivery system (IHCDS) and a tertiary medical care centre. We drew referents, matched for age and sex, from the IHCDS. Participants underwent comprehensive, structured telephone interviews eliciting details of occupational and home environmental exposures. We employed a hierarchical analytic approach for data reduction based on the false discovery rate method within clusters of exposures. We measured lung function and selected biomarkers in a subset of participants. We used multivariate logistic regression to estimate exposure-associated odds ratios (ORs) and population attributable fractions (PAFs) for HP.ResultsWe analysed data for 192 HP cases (148 IHCDS; 44 tertiary care) and 229 referents. Occupational exposures combined more than doubled the odds of developing HP (OR 2.67; 95% CI 1.73–4.14) with a PAF of 34% (95% CI 21–46%); nonoccupational bird exposure also doubled the HP odds (OR 2.02; 95% CI 1.13–3.60), with a PAF of 12% (3–21%). Lung function and selected biomarkers did not substantively modify the risk estimates on the basis of questionnaire data alone.DiscussionIn a case-referent approach evaluating HP risk, identifiable exposures accounted, on an epidemiological basis, for approximately two in three cases of disease; conversely, for one in three, the risk factors for disease remained elusive.


2020 ◽  
Vol 41 (02) ◽  
pp. 214-228
Author(s):  
Evans R. Fernández Pérez ◽  
Tilman L. Koelsch ◽  
Paolo M. Leone ◽  
Steve D. Groshong ◽  
David A. Lynch ◽  
...  

AbstractThis review provides an updated approach to the diagnosis and management of hypersensitivity pneumonitis (HP). The importance of using a multidisciplinary discussion to increase diagnostic and treatment confidence is emphasized. The role of Bayesian reasoning is highlighted throughout, underscoring the importance of hypothesis generation (differential diagnosis) and diagnostic test interpretation based on the probability of HP. Probability estimates of diagnostic certainty (i.e., a confident versus a working diagnosis) and treatment thresholds are carefully examined.Therapeutically, beyond antigen avoidance and newly available antifibrotic therapy for patients with a progressive fibrosing phenotype; the role, timing, and expected response to anti-inflammatory therapy in individual patients are unanswered questions. Since the evidence and validation of testing generally performed during the diagnostic work-up and longitudinal monitoring of HP is feeble at best, the viewpoints discussed are not intended to resolve current controversies but rather to provide a conceptual framework for evaluating discordant information when evaluating and caring for patients with HP.


2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Genta Ishikawa ◽  
Sakshi Dua ◽  
Aditi Mathur ◽  
Samuel O. Acquah ◽  
Mary Salvatore ◽  
...  

Background. We encounter interstitial lung disease (ILD) patients with psoriasis. The aim of this case series was to examine clinical and radiographic characteristics of patients with concomitant psoriasis and ILD. Methods. This is a retrospective review of our institutional experience of ILD concomitant with psoriasis, from the database in the Advanced Lung/Interstitial Lung Disease Program at the Mount Sinai Hospital. Out of 447 ILD patients, we identified 21 (4.7%) with antecedent or concomitant diagnosis of psoriasis. Clinical, radiographic, pathological, and outcome data were abstracted from our medical records. Results. Median age was 66 years (range, 46–86) and 14 (66.7%) were male. Thirteen (61.9%) had not previously or concomitantly been exposed to immunosuppressive therapy directed against psoriasis. Two (9.5%) ultimately died. Clinical diagnosis of ILD included idiopathic pulmonary fibrosis, 11 (52.4%); nonspecific interstitial pneumonia (NSIP), 2 (9.5%); cryptogenic organizing pneumonia, 2 (9.5%); chronic hypersensitivity pneumonitis, 2 (9.5%); and the others, while radiographic diagnosis included usual interstitial pneumonia pattern, 9 (42.9%); NSIP pattern, 6 (28.6%); organizing pneumonia pattern, 4 (19.0%); hypersensitivity pneumonitis pattern, 2 (9.5%); and the others. Conclusions. We report 21 ILD cases with antecedent or concomitant diagnosis of psoriasis. Further prospective studies are required to determine the association between ILD and psoriasis.


Author(s):  
Daniel Nan ◽  
Cristina Abraira-Meriel ◽  
Sandra de la Roz-Fernandez ◽  
Tamara Maestre-Orozco ◽  
Jose Luis Hernandez ◽  
...  

Coronavirus disease 2019 (COVID-19) is currently a major public health problem. The development of pulmonary fibrosis secondary to acute respiratory distress syndrome (ARDS) is one of the expected sequelae. In this case series, we describe five instances of the use of anakinra in late-phase COVID-19 pneumonia in hospitalized patients with pulmonary fibrosis and refractory respiratory failure fulfilling ARDS criteria. The study demonstrates that anakinra has promising efficacy and safety in late-phase COVID-19 infection in patients with ARDS and refractory hypoxaemia, and suggests its potential application as antifibrotic therapy in these patients.


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