Acute fibrinous and organising pneumonia: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Organising pneumonia is a distinct histopathological entity characterized by intra-alveolar buds of granulation tissue, called Masson bodies, which mainly comprise of activated fibroblasts and loose connective tissue. This histopathologic pattern has been described in idiopathic cases, characterizing cryptogenic organising pneumonia as well as in the context of pulmonary infection, drug-induced pneumonitis and following lung transplantation. Although distinct as a clinical and pathological entity, community organising pneumonia may present with atypical clinical and pathological features, such as intra-alveolar fillings of fibrin balls and organising tissue that resembles acute respiratory distress syndrome or diffuse alveolar damage. The latter characteristics constitute a recently described anatomoclinical entity called acute fibrinous and organising pneumonia.</p> <p>Case presentation</p> <p>Here, we describe a rare case of acute fibrinous and organising pneumonia, in an otherwise healthy 65-year-old Greek woman who complained of dry cough, fever, weight loss and progressive dyspnoea. She had never been a smoker. Her clinical symptoms showed a rapid deterioration in the two weeks before admission, despite a course of oral antibiotics. After excluding infection and malignancy with routine laboratory tests and flexible bronchoscopy, high resolution computed tomography and video assisted thoracoscopic lung biopsy were performed. Diagnosis was based on radiological features typical of community organising pneumonia coupled with pathologic features characteristic of acute fibrinous and organising pneumonia. The patient was treated with corticosteroids and showed excellent clinical and radiological response three months after treatment initiation.</p> <p>Conclusion</p> <p>Acute fibrinous and organising pneumonia is an extremely rare pathologic entity, often misdiagnosed as typical community organising pneumonia. To our knowledge, this is the seventh case of acute fibrinous and organising pneumonia in the literature, with no identifiable cause or association in a female patient, with no underlying lung disease or known exposures and with an unremarkable previous medical history. We highlight the need for careful review of lung biopsies from patients with clinical and radiologic characteristics typical of community organising pneumonia. Although it remains uncertain whether fibrin alters the favourable prognosis and treatment response of community organising pneumonia, it becomes obvious that a thorough pathologic review, apart from establishing the diagnosis of acute fibrinous and organising pneumonia, may predict a more unfavorable outcome therefore alerting the clinician to administer more aggressive and prolonged therapeutic regimens.</p

Reversed halo sign in pneumocystis pneumonia: a case report

<p>Abstract</p> <p>Background</p> <p>The reversed halo sign may sometimes be seen in patients with cryptogenic organizing pneumonia, but is rarely associated with other diseases.</p> <p>Case presentation</p> <p>We present a case study of a 32-year-old male patient with acquired immunodeficiency syndrome, who had previously been treated with chemotherapy for non-Hodgkin's lymphoma. A chest X-ray showed bilateral patchy infiltrates. High-resolution computed tomography revealed the reversed halo sign in both upper lobes. The patient was diagnosed with pneumocystis pneumonia, which was successfully treated with sulfamethoxazole trimethoprim; the reversed halo sign disappeared, leaving cystic lesions. Cases such as this one are rare, but show that the reversed halo sign may occur in patients who do not have cryptogenic organizing pneumonia.</p> <p>Conclusion</p> <p>Physicians can avoid making an incorrect diagnosis and prescribing the wrong treatment by carefully evaluating all clinical criteria rather than assuming that the reversed halo sign only occurs with cryptogenic organizing pneumonia.</p

Frequency and predictors of miliary tuberculosis in patients with miliary pulmonary nodules in South Korea: A retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Miliary pulmonary nodules are commonly caused by various infections and cancers. We sought to identify the relative frequencies of various aetiologies and the clinical and radiographic predictors of miliary tuberculosis (TB) in patients with miliary pulmonary nodules.</p> <p>Methods</p> <p>We performed a retrospective cohort study of patients who presented with micronodules occupying more than two-thirds of the lung volume, based on computed tomography (CT) of the chest, between November 2001 and April 2007, in a tertiary referral hospital in South Korea.</p> <p>Results</p> <p>We analyzed 76 patients with miliary pulmonary nodules. Their median age was 52 years and 38 (50%) were males; 18 patients (24%) had a previous or current malignancy and five (7%) had a history of TB. The most common diagnoses of miliary nodules were miliary TB (41 patients, 54%) and miliary metastasis of malignancies (20 patients, 26%). Multivariate analysis revealed that age ≤30 years, HIV infection, corticosteroid use, bronchogenic spread of lesions, and ground-glass opacities occupying >25% of total lung volume increased the probability of miliary TB. However, a history of malignancy decreased the probability of miliary TB.</p> <p>Conclusion</p> <p>Miliary TB accounted for approximately half of all causes of miliary pulmonary nodules. Young age, an immune-compromised state, and several clinical and radiographic characteristics increased the probability of miliary TB.</p

Μελέτη διαχυτών διαμέσων πνευμονοπαθειών. Αξιολόγηση με υπολογιστική τομογραφία υψηλής ευκρίνειας

Aim: to evaluate diffuse interstitial lung disease by means of HRCT. Patients-methods:124 patients were assessed by HRCT and conventional CT. Results:lymphangitic carcinomatosis presents specific HRCT signs. Qualification of polygonal lines contributes to differentiation from sarcoidosis. The presence of micronodules along bronchovascular bundles and subpleural areas is the key HRCT finding in sarcoidosis. HRCT reveals the characteristic signs of idiopathic pulmonary fibrosis and their subpleural predominance, as well as the early interstitial infiltration and bronchiolar abnormalities in collagen vascular diseases. A pattern of cresentic opacities surrounding areas of ground glass densities is potentially specific for diagnosis of boop. Circumferentially distributed ground-glass opacities arround the lungs are indicative of chronic eosinophilic pneumonia. Multiple cysts and cavitated micronodules are specific HRCT findings for histiocytosis-X.Σκοπός:η διερεύνηση των διάχυτων διάμεσων πνευμονοπαθειών με Υ.Τ υψηλής ευκρίνειας (ΥΤΥΕ). Ασθενείς-μέθοδος:μελετήθηκαν 124 ασθενείς με συμβατικής και υψηλής ευκρίνειας υπολογιστική τομογραφία. Αποτελέσματα: η ΥΤΥΕ αναδεικνύει παθογνωμικό πρότυπο στην λεμφαγγειακή καρκινωμάτωση. Ποσοτικοποίηση των πολυγωνικών δομών διαφοροποιούν τη νόσο από τη σαρκοείδωση. Οι μικροόζοι με περιβρογχοαγγειακή και υποϋπεζωτικοτική κατανομή συνιστούν το χαρακτηριστικό πρότυπο της σαρκοείδωσης. Η ΥΤΥΕ αναδεικνύει τις χαρακτηριστικές αλλοιώσεις και την υποϋπεζωκοτική εντόπισή τους στην ιδιοπαθή πνευμονική ίνωση όπως και την πρώιμη διάμεση διήθηση και βρογχιολική συμμετοχή στις κολλαλονοπάθειες. Ένα πρότυπο κυκλικών πυκνώσεων που περιβάλλουν περιοχές γαλακτοχώρου ύαλου θεωρείται ειδικό της αποφρακτικής βρογχιολίτιδος με οργανούμενη πνευμονία. Πολλές κύστεις και κοιλοτικοί όζοι αποτελούν παθογνωμικό εύρημα της ιστιοκυττάρωσης-Χ στην ΥΤΥΕ

The effect of 12-O-tetradecanoylphorbol-13-acetate on Sertoli cell morphology and cytoskeletal organization: an in vitro study by means of cryo-SEM and fluorescent techniques

By means of cryo-scanning electron microscopy (cryo-SEM) and fluorescent techniques, evidence is provided on how 12-O-tetradecanoylphorbol-13-acetate (TPA) affects Sertoli cell morphology and F-actin and vinculin organization in vitro. In order to visualize the morphological changes, the cells were observed with cryo-SEM. F-actin was localized using rhodamine (TRI)-phalloidin and vinculin using a primary monoclonal antibody and a second TRI-conjugated antibody. The results indicate that after the addition of 10(-7) M TPA, Sertoli cells begin to round up and their cytoplasm is retracted towards a central region. Actin bundle organization is disrupted and vinculin assumes a punctuate distribution throughout the cell. Thus, the reorganization of actin and vinculin and subsequent changes in cell morphology seem to be brought about by TPA affecting not only actin but also the protein vinculin which interacts with actin. A discussion is made concerning the effect of TPA on cytoskeletal reorganization, which is closely related to cell transformation. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserved