Evaluation of D-dimer as a predictor of severity, degree of pulmonary involvement and mortality in patients with COVID-19 / Avaliação do D-dímero como preditor de gravidade, grau de envolvimento pulmonar e mortalidade em pacientes com COVID-19

Objective: To verify D-dimer values to predict disease severity, degree of lung involvement and mortality in patients with COVID-19. Method: The D-dimer levels of 200 confirmed COVID-19 patients were prospectively measured in the Emergency Department of Razi Hospital of Ahvaz on the admission day, and its relations with the illness severity, computed tomography (CT) score, and mortality were assessed. Results: D-dimer level > 1.04 µg/mL and ≤ 1.12 µg/mL could indicate severe illness and high grade of pulmonary involvement but low risk of death. The mortality rate in the patients with D-dimer level > 1.12 µg/mL (was significantly higher than its rate in those with D-dimer level ≤ 1.12 µg/mL (17.2% x 1.5%; P:0.02). An independent positive correlation was found between D-dimer and Chest CT score as well as the disease severity (OR: 1.84; 95%CI:1.38 - 2.45; P:0.0001). Conclusion: D-dimer level > 1.12 µg/mL on the early stage of COVID-19 infection may independently predict the severe illness, high grade of pulmonary involvement, and high risk of death, indicating its beneficial role in timely management of critical patients.

Objetivo: Verificar os valores do D-dímero para predizer a gravidade da doença, o grau de envolvimento pulmonar e a mortalidade em pacientes com COVID-19. Método: Os níveis de dímero D de 200 pacientes confirmados com COVID-19 foram medidos, prospectivamente, no Departamento de Emergência do Hospital Razi de Ahvaz, no dia da admissão, e suas relações com a gravidade da doença, escore de tomografia computadorizada (CT) e mortalidade foram avaliadas. Resultados: Os níveis do D-dímero > 1,04 µg/mL e ≤ 1,12 µg/mL podem indicar doença grave e alto grau de envolvimento pulmonar, mas baixo risco de morte. A taxa de mortalidade nos pacientes com valor de D-dímero > 1,12 µg/mL foi significativamente maior do naqueles com nível de D-dímero ≤ 1,12 µg/mL (17,2% x 1,5%; P:0,02). Foi encontrada uma correlação positiva independente entre o D-dímero e o escore de CT de tórax e a gravidade da doença (OR: 1,84; IC 95%:1,38 - 2,45; P:0,0001). Conclusão: O nível do D-dímero > 1,12 µg/mL no estágio inicial da infecção por COVID-19 pode prever independentemente a doença grave, alto grau de envolvimento pulmonar e alto risco de morte, indicando seu papel benéfico no manejo oportuno de pacientes críticos.

A study on diagnostic efficacy of pulmonary imaging tool in patients with rheumatoid arthritis

Background: Pulmonary complication in Rheumatoid arthritis is major health concern in the field of rheumatology. So this study is to find out the sensitive imaging tool for detecting different types of pulmonary changes seen in RA.Methods: This is a comparative, analytical, cross sectional, Institution- based, single centre study. We included all adult willing patients of Rheumatoid arthritis (age >18) and selected them based on 2010 ACR/EULAR criteria. Severity was assessed by number of joints involve in both upper and lower limb, along with ESR, CRP, Anti CCP level. Chest x ray, PFT and HRCT thorax were done in all RA patients.Results: Out of 50 RA patients, pulmonary involvement was observed in 25 patients identified by Spirometry, CXR, HRCT. Pulmonary involvement is more common in age group <40 years. Most common form of pulmonary involvement is ILD followed by obstructive lung disease like chronic bronchitis, bronchiectasis etc. HRCT is the most common tool for detection of Pulmonary involvement in rheumatoid arthritis. HRCT abnormality, most are Restrictive on spirometry (FEV1/FVC) <80% of predicted value. And this relation is statistically significant as P value is 0.001 (<0.05) by Chi-Square test. Patients having more the disease duration, more the pulmonary involvement. This association is statically significant as p value is 0.001 (<0.05).Conclusions: High resolution CT thorax is more sensitive modality for detection of pulmonary pathology in rheumatoid arthritis. Because of its high cost, availability of this imaging technique is beyond the lower socio-economic group where chest x ray may be useful.

Investigation of pulmonary involvement in inflammatory bowel disease in an experimental model of colitis

BACKGROUND/AIMS: Inflammatory bowel disease (IBD) may also involve various extra-intestinal organs. Clinical studies have found asymptomatic/symptomatic pulmonary involvement in 1% to 6% of patients with IBD. The present study histopathologically investigated pulmonary involvement in an experimental model of colitis in order to demonstrate pulmonary tissue involvement in IBD and to expose potential etiological factors. It also explored the relation between inflammation and tissue concentrations of vascular endothelial growth factor (VEGF) and tumor necrosis factor α (TNF-α). METHODS: The study comprised 24 male Wistar albino rats. The rats were divided into four groups of six rats each. Acute colitis was induced in two separate groups using either the dextran sulphate sodium (DSS) or trinitrobenzene sulfonic acid (TNBS) method, while the other two groups were used as controls for each model of colitis. Wallace scoring was used for macroscopic assessment of colitis, and the lungs were histopathologically examined. Concentrations of VEGF and TNF-α in pulmonary tissue were measured by the enzyme-linked immunosorbent assay method. RESULTS: The number of animals that had alveolar hemorrhage was significantly higher in the TNBS-induced colitis and DSS-induced colitis groups compared to their own control groups (p = 0.015 and p = 0.015, respectively). VEGF and TNF-α concentrations in pulmonary tissues were significantly increased in both the TNBS colitis and DSS colitis groups compared to their own control groups (p = 0.002 and p = 0.004, respectively; and p = 0.002 and p = 0.002, respectively). CONCLUSIONS: The present study demonstrated that significant and serious histopathological changes directly associated with colitis occur in the lungs in IBD.

Exacerbation of hypereosinophilic syndrome with pulmonary involvement in two consecutive pregnancies: a case report and review of the literature.

Hypereosinophilic syndrome represents a heterogeneous group of disorders with the common feature of prolonged eosinophilia of unknown cause and organ system dysfunction including the pulmonary system. Hypereosinophilic syndrome, with and without pulmonary involvement, in association with pregnancy is very rare, and to the best of our knowledge only one case of hypereosinophilic syndrome with pulmonary involvement during pregnancy has been previously reported in the medical literature. We describe a case of a patient with previously symptomatic hypereosinophilic syndrome with pulmonary involvement who experienced exacerbations of her disease during two consecutive pregnancies. To the best of our knowledge this is the first report which demonstrates a worsening effect of pregnancy on both eosinophil count and end organ involvement in a patient with previous diagnosis of hypereosinophilic syndrome.

An unusual case of childhood sarcoidosis: Un caso clínico infrecuente / Sarcoidosis infantil

Sarcoidosis is a systemic granulomatous disease of unknown etiology that may affect many systems, mainly lungs. Most of the patients present at stages I and II lung involvement. Pulmonary infltrates without hilar lymphadenopathy (state III) rarely occurs. Extrapulmonary organ involvement is common in pediatric sarcoidosis. The aim of this report is to present an unusual case of childhood sarcoidosis with stage III lung involvement without any extrapulmonary organ involvement. A 7-year-old girl presented with the complaints of malaise, fatigue, weight loss and dyspnea. There was patchy, bilateral ground glass view at high resolution computer tomography. Video assisted thoracoscopic lung biopsy was performed and histopathological examination showed nonnecrotising epitheloid-cell granulomas with giant cells. She did not have any hilar or extrapulmonary organ involvement and pulmonary sarcoidosis at stage III was diagnosed. Sarcoidosis should be considered in the differential diagnosis of children with interstitial lung disease.

La sarcoidosis es una enfermedad granulomatosa sistémica de etiología desconocida que puede afectar varios órganos, principalmente el pulmón. La mayoría de los pacientes presentan estadios I y II de compromiso pulmonar. Los infltrados pulmonares, sin linfadenopatías hiliares (estadio III), son infrecuentes. El compromiso de órganos extrapulmonares es común en la sarcoidosis infantil. El objetivo es presentar un caso infrecuente de sarcoidosis infantil con compromiso pulmonar en estadio III sin afectación de los órganos extrapulmonares. Una niña de 7 años consultó por malestar general, fatiga, pérdida de peso y disnea. En la tomografía computarizada de alta resolución se observó un infltrado bilateral de tipo esmerilado. Se realizó una biopsia pulmonar por videotoracoscopia. La histopatología mostró granulomas no necrosantes de células epitelioides con células gigantes. No había compromiso hiliar ni de otros órganos, por lo que el diagnóstico fue de sarcoidosis en estadio III. La sarcoidosis debe considerarse en el diagnóstico diferencial de los niños con enfermedad intersticial pulmonar.

Pulmonary manifestations in inflammatory bowel disease: a prospective study.

Background Although pulmonary abnormalities have been recognized in patients with inflammatory bowel diseases (IBD), their prevalence and clinical significance are not known. Aim To study the prevalence and clinical significance of pulmonary abnormalities in patients with IBD. Methods Ninety-five non-consecutive patients with IBD (12 Crohn’s disease, 83 ulcerative colitis; mean age 41.9 [SD 13] years; 47 women) were prospectively studied from January 2007 to March 2010. Pulmonary function tests (PFT) and high-resolution CT (HRCT) chest were performed in them. PFT were compared to those in 270 healthy (control) subjects matched for age, sex and smoking status. Results Twenty-seven (28.5%) patients and 11 (4%) control subjects had abnormal PFT (p<0.0001). Small airway obstruction was seen in 18 patients, restrictive defect in six and mixed defect in three. Twenty-one (22%) patients had abnormal HRCT findings – bronchiectasis and nodules (nine patients each, including one with nodules who later developed active tuberculosis after infliximab therapy), parenchymal bands (8), mediastinal lymphadenopathy (five, including two with tuberculosis on histology and culture), emphysema (5), brochiolitis (2), pleural effusion or thickening (2), pericardial effusion (2), patchy consolidation (1), ground-glass opacities (1) and lung metastasis (1). Three patients had symptoms (one asthma, two cough). Conclusion PFT and HRCT chest showed abnormality in about one-quarter of patients with IBD. A majority of patients with these abnormalities were asymptomatic.

Hepato-pulmonary amebiasis: a case report

Infections with Entamoeba histolytica are seen worldwide and are more prevalent in the tropics. About 90 percent of infections are asymptomatic, and the remaining 10 percent produce a spectrum of clinical syndromes, ranging from dysentery to abscesses of the liver or other organs. Extra-intestinal infection by E. histolytica most often involves liver. Pleuro-pulmonary involvement, seen as the second most common extra-intestinal pattern of infection, is frequently associated with amebic liver abscess. Pulmonary amebiasis occurs in about 2-3 percent of patients with invasive amebiasis. We report herein the case of a 45-year-old male presenting with hepato-pulmonary amebiasis. The diagnosis was established from direct examination of sputum, in which trophozoites of E. histolytica were detected, and by serology. Following treatment with metronidazole and chloroquine, the clinical evolution improved significantly. On regular follow-up visits, the patient was asymptomatic. This case report reiterates the need for collaboration between clinicians and microbiologists for timely diagnosis of such infections.

Clinical features of leptospirosis experienced in a university hospital between 2001 and 2007 / 대한내과학회지

BACKGROUND/AIMS: Leptospirosis is a zoonotic disease of global importance. In addition, pulmonary involvement of this disease has been increasingly reported in recent decades. The present study was performed to analyze the clinical features of leptospirosis experienced during recent years and to investigate the clinical significance of pulmonary involvement. METHODS: Patients with serologically confirmed leptospirosis who visited Chonnam National University Hospital from 2001 to 2007 were enrolled in this study. Epidemiologic characteristics, clinical features, laboratory findings, and outcomes of patients with leptospirosis were analyzed. RESULTS: Among a total of 68 patients, 47 (69.1%) had a history of occupational exposure. Fever (88.2%), myalgia (80.9%), headache (69.1%), hypotension (51.5%), dyspnea (44.1%), and abdominal pain (55.9%) were commonly observed. The overall case fatality rate was 5.8%. In the group of patients with pulmonary involvement (n=44), dyspnea, hemoptysis, renal dysfunction, and thrombocytopenia were more frequently observed than in patients without pulmonary involvement (n=24). Mixed type presentations and the use of mechanical ventilation were more commonly observed in patients with pulmonary involvement as compared to patients without pulmonary involvement. CONCLUSIONS: Leptospirosis with pulmonary involvement is common and may have severe clinical outcomes. Therefore, close monitoring and intensive care is important for patients with leptospirosis and pulmonary involvement.

Acute pulmonary manifestation in ulcerative colitis / 대한내과학회지

The ulcerative colitis is a chronic inflammatory bowel disease of unknown etiology. The major symptoms of ulcerative colitis are diarrhea, hematochezia, tenesmus, and abdominal pain. However, occasionally the arthritis, skin disorders, hepatobiliary inflammation, and uveitis are recognized systemic complications or extracolonic manifestations of ulcerative colitis. Though there have been rare reports of coexistent pulmonary and inflammatory bowel disease, the lung is not generally considered a target organ in ulcerative colitis. Since the first observation of pulmonary involvement in ulcerative colitis by Kraft in 1976, a few cases have been reported. We describe of a patient with ulcerative colitis and extracolonic manifestations in whom pulmonary involvement developed that was responsive to corticosteroid therapy.

A Case of Sjogren's Syndrome with Interstitial Lung Disease and Multiple Cystic Lung Disease / 결핵

A 47-years-old woman presented with a 2-month history of a dry mouth and dry cough. The patient had been taking medication for Sjogren's syndrome for approximately 7 years. The chest radiography showed multiple cystic lesions and a hazy density in both lower lung fields. The HRCT showed a diffuse ground glass like appearance and multiple variable sized cystic lesions in both lung fields. After medication, the symptoms were aggravated. Bronchoscopy was preformed with a transbronchial lung biopsy. The biopsies showed an infiltration of lymphocytes, neutrophils, monocytes and histiocytes through the interstitial space of the alveola and a widening of the alveolar septa. However, the histological findings of the cysts were not obtained. Sjogren's syndrome is a slowly progressive inflammatory autoimmune disease, which is characterized by lymphocyte mediated destruction of the exocrine glands, with pulmonary involvement in approximately 19-65%, High-resolution CT is a sensitive technique for assessing the pulmonary involvement in patients with Sjogren's syndrome. Although a lung biopsy is not always necessary for establishing a diagnosis of an interstitial lung disease in Sjogren's syndrome. A lung biopsy may reveal a wide spectrum of changes ranging from a mild inflammatory response to end stage fibrosis with honeycombing. Because of the predominantly peribronchiolar inflammatory infiltration and inspissated secretions the cysts were suspected to have been formed by the ballvalve phenomenon. However, no definite evidence was obtained.

A case of Waldenstr's Macroglobulinemia with Pleural Involvement / 대한임상병리학회지

Waldenstr's macroglobulinemia is a slowly progressing disease characterized by proliferation of small lymphocytes, plasmacytoid lymphocytes and plasma cells in the bone marrow with increased serum monoclonal IgM. Since 1944, only a few cases of Waldenstr's macroglobulinemia with pulmonary involvement have been described. We experienced a case of Waldenstr's macroglobulinemia with pulmonary involvement. The patient was 66-year-old male complaining dyspnea. His cytological finding of pleural fluid aspirates revealed many plasmacytoid lymphocytes. Serum electrophoresis showed the sharp M-peak in the gamma globulin region, which was identified as a IgM, kappa type by immunofixation. Bone marrow findings showed small lymphocytic and plasmacytoid lymphocytic infiltration.

The Utility of Immunological Markers and Pulmonary Function Test in the Early Diagnosis of Pulmonary Involvement in the Patients with Rheumatoid Arthritis / 결핵

BACKGROUND: It is reported that frequency of pulmonary involvement in the patients with rheumatoid arthritis reaches 10 to 50% and pulmonary involvement is a principal cause of death. As immunology and radiology has developed, interest for the early diagnosis of pulmonary involvement is increasing. METHOD: Among the patients at Hanyang University Hospital from March, 1990 to July, 1995, we compared the 29 patients having pulmonary involvement with the 18 patients controls in clinical and chest high resolution computed tomography(HRCT) findings by immunological markers and findings of pulmonary function test. We sought useful markers for early diagnosis of pulmonary involvement with noninvasive investigations. RESULTS: The ratio of males to females was 14: 15 in the group of pulmonary involvement, and all of the 18 patients were females in the control group. Smoking history was 31%(9/29) in the former group and none in the latter group. Rheumatoid factor(RF) was positive in 96.5%(28/29) of the pulmonary involvement group and in 100%(18/18) of the control group(p=0.12). Antiperinuclear factor(APF) showed a significant difference: 86.9%(20/23, average value: 2.0) was positive in the pulmonary involvement group and 50%(8/16, average value: 1.1) in the control group(p=0.04). Antinuclear antibody(ANA) was positive in 60.7%(17/28) of the pulmonary involvement group and in 72.2%(13/18) of the control group(p=0.33). Cryoglobulin, also showed a significant difference: 72%(18/25) in the pulmonary involvement group was positive and 56.2% (9/16) in the control group was positive(p=0.02). Bony erosion was positive in 61.5%(16/26) of the pulmonary involvement group and in 77.7%(14/18) of the control group(p=0.8). On the pulmonary function test, the average value of alveolar volume corrected diffusion capacity and residual volume in the pulmonary involvement group and in the control group were 1.07mmol/min/KPa(predicted value: 64.2%), 1.32L(predicted value: 70%)and 1.44mmol/min/KPa, 3.75L(predicted value: 86.6%), respectively(p=0.003, p=0.004), showing a significant difference. CONCLUSION: APF or cryoglobulin on the serological test, the measurement of residual volume and alveolar volume corrected diffusion capacity may be used as effective markers in the diagnosis of pulmonary involvement of the patients with rheumatoid arthritis.

Pulmonary involvement with massive pneumothorax in a child with Langerhams Cell Histiocytosis (LCH).

An eight-year-old boy with pulmonary LCH, who had spontaneous pneumothorax, prolonged air leak and recurrence of puneumothorax after re-expansion of the lung was described. Medical pleurodesis was successfully employed to prevent recurrence of the air leak.

Primary Lymphomatoid Granulomatosis in the Frontal Lobe: Case Report

We report a case of cerebral lymphomatoid granulomatosis in a 50-year-old man. Lymphomatoid granulomatosis is an unusual condition which usually presents as a pulmonary manifestation, which occasionally affects the brain, and causes focal inflammatory lesions. Primary cerebral lymphomatoid granulomatosis is very rare. We describe a case of lymphomatoid granulomatosis in the left frontal lobe without pulmonary involvement.