Tuberc Respir Dis.  2008 Oct;65(4):328-333.

Recurrent Desquamative Interstitial Pneumonia with Fibrotic Lung Disease

• Kim WJ
• Choi JH
• Park YB
• Cho SW
• Nam ES
• Mo EK

Abstract

Desquamative interstitial pneumonia is an uncommon form of interstitial lung diseases and it has a good prognosis compared with other types of idiopathic interstitial pneumonia. A 69-year old man was admitted to our hospital because of a 3-month history of dyspnea. The patient presented with hypoxemia. High-resolution computerized tomography of the patient showed ground glass opacity and traction bronchiectasis with subpleural early honeycombing on the both lung fields. The pathologic findings of the video-assisted thoracoscopy lung biopsy were compatible with desquamative interstitial pneumonia, and irregularly distributed interstitial fibrosis and inflammation were observed at the peripheral parenchyme. Oral predinsolone was started; his symptoms and chest x-ray were improved, and so he stopped taking the prednisolone. Ten months later, the desquamative interstitial pneumonia recurred. We report here on a case of recurrent desquamative interstitial pneumonia with fibrotic lung disease.

Keyword

Desquamative interstitial pneumonia; Recurrent; Fibrotic lung disease

MeSH Terms

Anoxia
Biopsy
Bronchiectasis
Dyspnea
Fibrosis
Glass
Humans
Idiopathic Interstitial Pneumonias
Inflammation
Lung
Lung Diseases
Lung Diseases, Interstitial
Prednisolone
Prognosis
Thoracoscopy
Thorax
Traction
Prednisolone

Figure

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  Figure 1 (A) At initial presentation, chest x-ray shows ground glass opacity on both lung field. (B) After prednisolone treatment, ground glass opacity is improved.

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  Figure 2 HRCT scan shows ground glass opacity, reticular opacities with traction bronchiectasis (arrow) and multiple cystic change with early honeycombing (arrowhead).

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  Figure 3 Thoracoscopic lung biopsy of right middle and lower lobes. (A) Alveolar space is filled with amorphous materials (H&H stain, ×10). (B) Interstitium has fibrotic change and alveolar space is filled with alveolar macropahge. Cytoplasm of alveolar space has deep eosinophil, basophilic color. It may be fragment of squamous cell (H&H stain, ×200). (C) At the peripheral parenchyme, irregularly distributed interstitial fibrosis and inflammation are noted with adjacent area of alveolar space filled with alveolar macrophages (H&H stain, ×100).

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  Figure 4 (A) In 10 month after, stopping prednisolone, chest X-ray shows ground glass opacity on both lower lobes. (B) HRCT shows diffuse ground glass opacity in both lung fields. Reticular opacities with traction bronchiectasis was improved compared with previous CT scan. (C) Early honeycombing is still remained in both lower lobes.

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  Figure 5 After 5 month follow up, ground glass opacity was improved.

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