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Table of Contents
LETTER TO THE EDITOR
Year : 2013  |  Volume : 3  |  Issue : 1  |  Page : 93-94

A 50 year old man with progressive cough and exertional dyspnea


Department of Pulmonary and Critical Care, University of Florida, Jacksonville, Florida, USA

Date of Web Publication22-Mar-2013

Correspondence Address:
Hammad Bhatti
Department of Pulmonary and Critical Care, 655 W 8th street, Jacksonville, Florida 32209
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.109433

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How to cite this article:
Bhatti H, Usman F. A 50 year old man with progressive cough and exertional dyspnea. Int J Crit Illn Inj Sci 2013;3:93-4

How to cite this URL:
Bhatti H, Usman F. A 50 year old man with progressive cough and exertional dyspnea. Int J Crit Illn Inj Sci [serial online] 2013 [cited 2019 Dec 10];3:93-4. Available from: http://www.ijciis.org/text.asp?2013/3/1/93/109433

Sir,

Organizing pneumonia (OP) is one of the idiopathic interstitial pneumonias, histologically characterized by involvement of alveoli and bronchioles filled with fibroblastic tissue. We present a case of a patient where diagnosis was made on a transbronchial lung biopsy.

A 50 year old male with human immunodeficiency virus (HIV) on highly active antiretroviral therapy and with HCV on pegylated interferon alfa-2b (peg) and ribavirin for the last twelve weeks was admitted to the hospital after complaining of cough and exertional dyspnea for four weeks. Vital signs were significant for a temperature of 103.2 F. His physical exam was remarkable for diminished breath sounds bilaterally. Last CD4 count was 333 cells/uL with an undetectable viral load. An ABG on RA showed a PH of 7.43, PC02 31, PO2 73. A Chest radiograph showed bilateral lower lobe interstitial infiltrates [Figure 1]. HRCT revealed diffuse patchy ground glass infiltrates in the lungs bilaterally [Figure 2]. Bronchoscopy with bronchoalveolar lavage was negative for bacterial, fungal and mycobacterial culture as well as cytomegalovirus and herpes simplex virus. A repeat bronchoscopy with transbronchial biopsy was performed which showed an organizing pneumonia (OP) pattern on histology [Figure 3]. Peg interferon was discontinued and the patient was started on prednisone 60 mg daily. He responded dramatically within four days of therapy as seen on repeat chest radiograph [Figure 4]."
Figure 1: Chest radiograph showing bilateral lower lobe interstitial infiltrates

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Figure 2: High resolution computed tomography showing bilateral diffuse ground glass infiltrates

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Figure 3: Lung with intra-alveolar plugging with fibroblast, loose connective tissue and fibrin (H and E; 400x magnification)

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Figure 4: Chest radiograph showing resolution of bilateral lower lobe interstitial infiltrates after corticosteroid therapy

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Pulmonary toxicity in combination therapy with pegylated interferon alfa-2b (peg) is rare. Reported side effects include interstitial pneumonitis, a sarcoid like reaction, bronchiolitis obliterans organizing pneumonia, asthma exacerbations, acute respiratory distress syndrome, pleural effusions and organizing pneumonia. [1]

OP pneumonia was first described as a cause of non-resolving bacterial pneumonia; however it has been associated with other causes including vasculitides and drugs. Patients with OP present with an insidious respiratory illness. The radiological findings may reveal peripheral consolidation, ground glass infiltrates or solitary nodules. [2] The definitive diagnosis of OP requires tissue examination obtained through open lung biopsy, video assisted thoracoscopy or transbronchial biopsy. [3] Corticosteroids are the current standard of treatment and result in rapid clinical and radiographic recovery. [3]

In summary, OP should be considered in patients with HCV with symptoms of cough and dyspnea while on therapy with peg interferon and transbronchial lung biopsy should be considered before consideration of more invasive biopsy procedures.

 
   References Top

1.Midturi J, Sierra-Hoffman M. Spectrum of pulmonary toxicity associated with the use of interferon therapy for hepatitis C: Case report and review of the literature. Clin Infect Dis 2004;39:1724-9.  Back to cited text no. 1
    
2.Drakopanagiotakis F, Polychronopoulos V, Judson MA. Organizing pneumonia. Am J Med Sci 2008;335:34-9.  Back to cited text no. 2
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3.Slavenburg S, Heijdra Y, Drenth J. Pneumonitis as A consequence of (Peg) interferon-ribavirin combination therapy for hepatitis C. Dig Dis Sci 2010;55:579-85.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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