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A CASE OF ANKLE SURGERY CAUSING SEVERE IDIOPATHIC PULMONARY FIBROSIS (IPF) EXACERBATION: SHOULD I ALLOW MY PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS UNDERGO SURGERY?
Chest ; 162(4):A1806-A1807, 2022.
Article in English | EMBASE | ID: covidwho-2060867
ABSTRACT
SESSION TITLE Critical Diffuse Lung Disease Cases 1 SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 1245 pm

INTRODUCTION:

Acute exacerbations (AE) of idiopathic pulmonary fibrosis (IPF) are well recognized in the progression of this uniformly fatal disease. Here we describe a case of AE of undiagnosed IPF after ankle surgery. Our aim is to discuss the role of non-pulmonary surgery as a precipitating factor and its outcome. CASE PRESENTATION The patient is a 61-year-old male with a medical history of chronic smoking, recent open reduction internal fixation of left ankle 5 days before the presentation, comes to the emergency room with acute onset, gradually worsening shortness of breath along with non-productive cough and pleuritic chest pain. He denied any sick contacts, COVID exposure, travel history, inhalation of toxic fumes, or any chemical/pets/bird exposure. He was saturating around 85% on room air, was switched to a nasal cannula with improvement in saturation. Computed tomography (CT) of the chest showed no evidence of pulmonary embolism but diffuse ground-glass opacities (GGO) were noted bilaterally with no effusion or emphysematous changes, which were new compared to CT chest 10 days prior (that is 5 days before ankle surgery) which showed only mild reticular opacity along anterior convexity of the lungs bilaterally. He was started on intravenous steroids with gradual improvement in clinical status. Bronchoscopy biopsies revealed no malignant cells, bronchoalveolar lavage with no infections, and a negative serum autoimmune panel. He was discharged with outpatient follow-up for a repeat CT chest 6 weeks later which showed improvement in GGO (not back to baseline) and he was still requiring oxygen support.

DISCUSSION:

The most common triggers for IPF are smoking, environmental toxins, viral (COVID infection) or bacterial infections, medications like antidepressants, beta-blockers, NSAIDs. There is increasing evidence that surgery can cause acute respiratory worsening in IPF, presumably through increased mechanical stress to the lungs. Prolonged mechanical ventilation, high tidal volume, and high concentration of supplemental oxygen during surgery have been proposed as potential causes(1). As per the results from the retrospective study, the incidence of postoperative AE of IPF in patients undergoing non-pulmonary surgery is slightly lower than in patients undergoing pulmonary surgery (2,3). As in our case, non-pulmonary surgery procedures can pose risk for IPF exacerbation, but at this time we have limited research evidence to conclude if this exacerbation can alter the course of the disease. Some studies showed preoperative elevated C-reactive protein as a possible risk factor for AE of IPF after a non-pulmonary surgery but a multicenter study is needed to clarify the preoperative risk factors for AE of IPF after non-pulmonary surgery.

CONCLUSIONS:

We need further studies to check risk factors and disease course alteration, to have better guidance to classify preoperative risk in our IPF patients. Reference #1 Acute Exacerbation of Idiopathic Pulmonary Fibrosis A Proposal, PMID 2441663 Reference #2 Exacerbations in idiopathic pulmonary fibrosis triggered by pulmonary and non-pulmonary surgery a case series and comprehensive review of the literature, PMID 22543997 Reference #3 Postoperative acute exacerbation of interstitial pneumonia in pulmonary and non-pulmonary surgery a retrospective study DISCLOSURES No relevant relationships by Arundhati Chandini Arjun No relevant relationships by Harshil Fichadiya no disclosure submitted for Boning Li;No relevant relationships by Gaurav Mohan No relevant relationships by Rana Prathap Padappayil No relevant relationships by Raghu Tiperneni
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Journal: Chest Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Journal: Chest Year: 2022 Document Type: Article