ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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A Case of Relapsing Desquamative Interstitial Pneumonia
Session Title
TP34 - TP034 INTERESTING DIFFUSE PARENCHYMAL LUNG DISEASE CASES
Abstract
A2093 - A Case of Relapsing Desquamative Interstitial Pneumonia
Author Block: T. Jahir1, S. Hossain2, M. Xie3, C. Jiang4; 1Pulmonary Medicine, Department of Internal Medicine, Interfaith Hospital Medical Center, Brooklyn, NY, United States, 2Department of Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States, 3Department of Clinical Research, Jamaica Hospital Medical Center, Jamaica, NY, United States, 4Medicine - Pulmonary Disease, Jamaica Hospital Medical Center, Jamaica, NY, United States.
Introduction: Desquamative interstitial pneumonia (DIP) accounts for <3% of interstitial lung disease cases and is mostly seen in middle-aged cigarette smokers. Typical features include chronic cough and dyspnea, ground-glass opacities (GGOs) in the middle and lower zones radiologically, and a restrictive pulmonary function pattern. Smoking cessation can result in disease reversal. We present the case of a 57-year-old man with recurrent DIP developing after restarting smoking.Description: A 57-year-old man with a two-year history of chronic dyspnea and a 40-pack-year smoking history presented to the emergency room with a one-month history of worsening dyspnea on exertion and at rest associated with chest tightness, wheezing, two-pillow orthopnea, and two-block exercise tolerance. Oxygen saturation was 92% on room air, there were basal inspiratory rales on auscultation and finger clubbing. Arterial blood gas showed a pO2 of 63mmHg on room air. There was a patchy interstitial infiltrate with lower lung predominance on X-ray, and chest CT showed peripheral bilateral lower zone GGOs, no honeycombing, possible small lung cysts, and emphysematous changes. Infectious disease, auto-immune, and hypersensitivity pneumonitis panels were negative. Pulmonary function testing showed a restrictive pattern with low DLCO. Surgical VATS biopsy revealed features of desquamative interstitial pneumonitis. After smoking cessation and prednisone treatment, his symptoms improved significantly, and exercise tolerance improved to about six blocks with commensurate improvements in his pulmonary function testing. Two and a half years later, he resumed smoking and was rehospitalized for acute hypoxemic respiratory failure due to the progression of DIP. After another course of corticosteroids, he was discharged on home oxygen and chronic prednisone use as well as intensive lifestyle modification. After achieving smoking cessation again followed by a prolonged steroid taper over six months, his symptoms again improved significantly with accompanying improvements in radiologic and pulmonary function parameters. Discussion: DIP in most patients (90%) is smoking-related. This case emphasizes the importance of early diagnosis and smoking cessation efforts. These efforts can prevent further disease progression and potentially lead to complete reversibility and overall survival of ~70% after ten years. However, continued smoking can result in progressive disease and end-stage lung disease.
Author Block: T. Jahir1, S. Hossain2, M. Xie3, C. Jiang4; 1Pulmonary Medicine, Department of Internal Medicine, Interfaith Hospital Medical Center, Brooklyn, NY, United States, 2Department of Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States, 3Department of Clinical Research, Jamaica Hospital Medical Center, Jamaica, NY, United States, 4Medicine - Pulmonary Disease, Jamaica Hospital Medical Center, Jamaica, NY, United States.
Introduction: Desquamative interstitial pneumonia (DIP) accounts for <3% of interstitial lung disease cases and is mostly seen in middle-aged cigarette smokers. Typical features include chronic cough and dyspnea, ground-glass opacities (GGOs) in the middle and lower zones radiologically, and a restrictive pulmonary function pattern. Smoking cessation can result in disease reversal. We present the case of a 57-year-old man with recurrent DIP developing after restarting smoking.Description: A 57-year-old man with a two-year history of chronic dyspnea and a 40-pack-year smoking history presented to the emergency room with a one-month history of worsening dyspnea on exertion and at rest associated with chest tightness, wheezing, two-pillow orthopnea, and two-block exercise tolerance. Oxygen saturation was 92% on room air, there were basal inspiratory rales on auscultation and finger clubbing. Arterial blood gas showed a pO2 of 63mmHg on room air. There was a patchy interstitial infiltrate with lower lung predominance on X-ray, and chest CT showed peripheral bilateral lower zone GGOs, no honeycombing, possible small lung cysts, and emphysematous changes. Infectious disease, auto-immune, and hypersensitivity pneumonitis panels were negative. Pulmonary function testing showed a restrictive pattern with low DLCO. Surgical VATS biopsy revealed features of desquamative interstitial pneumonitis. After smoking cessation and prednisone treatment, his symptoms improved significantly, and exercise tolerance improved to about six blocks with commensurate improvements in his pulmonary function testing. Two and a half years later, he resumed smoking and was rehospitalized for acute hypoxemic respiratory failure due to the progression of DIP. After another course of corticosteroids, he was discharged on home oxygen and chronic prednisone use as well as intensive lifestyle modification. After achieving smoking cessation again followed by a prolonged steroid taper over six months, his symptoms again improved significantly with accompanying improvements in radiologic and pulmonary function parameters. Discussion: DIP in most patients (90%) is smoking-related. This case emphasizes the importance of early diagnosis and smoking cessation efforts. These efforts can prevent further disease progression and potentially lead to complete reversibility and overall survival of ~70% after ten years. However, continued smoking can result in progressive disease and end-stage lung disease.
