[New classification of interstitial lung disease].
ABSTRACT The pathological classification of interstitial lung disease (ILD) includes two general groups, diffuse infiltrative pneumonia with a specific histological presentation due to primary disease of unknown or unrecognized cause and idiopathic ILD. Diagnosis is established on the basis of clinical, radiological and pathological findings. In the first group of diffuse infiltrative pneumonia, the diagnosis is usually straightforward, established on endoscopic biopsy, alveolar lavage or surgical material depending on the case. The pathological classification of idiopathic ILD requires a surgical specimen. The entities redefined by the American Thoracic Society and the European Respiratory Society (ATS/ERS) are: usual interstitial pneumonia, non specific interstitial pneumonia, chronic organized pneumonia, diffuse alveolar damage, desquamative interstitial pneumonia, desquamative interstitial pneumonia with respiratory bronchiolitis and lymphocytic interstitial pneumonia. The diagnosis of idiopathic pulmonary fibrosis is established in a precise clinical and radiological context with an aspect of common interstitial pneumonia of the biopsy material. It is important to recognized common interstitial pneumonia because of the severe prognosis and to distinguish it from non-specific ILD.
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ABSTRACT: Immunosuppressants and immunomodulators are designed to regulate excessive immune response responsible for inflammatory lesions and are prescribed more and more in internal medicine. These drugs are known for their efficiency but with a significant toxicity including interstitial lung disease (ILD). Some factors liable to pulmonary toxicity include advanced age, genetic polymorphism and the existence of prior pulmonary disease. Cytotoxicity and hypersensitivity are the main mechanisms of pulmonary toxicity. There is no universal classification of drug induced-lung disease. Theoretically, drugs may be responsible for all histological aspects of ILD. Methotrexate is the most well-known drug as a provider of ILD with a prevalence of 0.3 to 11.6%. Some cases of ILD have also been reported with the new biologics used in systemic diseases. The diagnostic approach to the suspicion of drug ILD is to eliminate non-medicinal causes of pneumonia including infections and tumors before exploring the clinical symptomatology and the results of imaging and bronchoalveolar lavage cell profile. The analysis of the clinical symptomatology check the compatibility of the chronology of clinical and/or radiological pneumonia with the medication suspected. Subsequently, data from the clinical case are compared with those of the literature. Treatment involves stopping the suspected drug. The use of corticosteroids may be required in case of signs of severity or a lingering evolution.Revue de Pneumologie Clinique 10/2013; · 0.20 Impact Factor
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ABSTRACT: A 31-year-old woman with a prior history of an overlap syndrome of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) developed fever, pericarditis with pericardial effusion and a rapidly progressive fatal interstitial lung disease. Diagnostic test and procedures, differential diagnosis and therapeutic approach are discussed.Reumatología clinica. 7(1):61-7.