Relapsing polychondritis: new pulmonary manifestations.

Relapsing polychondritis is purported to be an autoimmune disease characterized by inflammation of cartilaginous structures including the nose, ears, glottis, trachea, and mainstem bronchi. Arthropathy, aortopathy, scleritis, conjunctivitis, iritis, vertigo, otitis media, glomerulonephritis, and skin lesions are common manifestations. We have recently cared for an elderly nonsmoker with a history of abdominal aortic aneurysm repair and recurrent bouts of painful ear swelling who presented with a pulmonary infiltrate and pulmonary function studies suggestive of small airways disease. Subsequent transbronchial biopsy revealed no pathogens but was associated with excessive bleeding, perhaps suggestive of a vasculitic process in the lung. The pulmonary infiltrate cleared over a 2-month interval with the use of corticosteroids. Unusual in this otherwise classical case of relapsing polychondritis was that the pulmonary infiltrate and small airways disease were the prominent pulmonary manifestations and no tracheobronchial abnormalities were visualized.

Lymphangiomyomatosis: hormonal implications in etiology and therapy.

When a 34-year-old woman had dyspnea and chylothorax 8 months postpartum, lymphangiomyomatosis was diagnosed by open-lung biopsy. Baseline laboratory studies to evaluate infertility had revealed normal hormonal levels. She was subsequently treated with various hormones to aid in conception and in sustaining pregnancy. Her condition has improved with progesterone therapy. This case raises concern about the possible adverse consequences of hormonal manipulation in treating infertility. The need for open-lung biopsy in patients with classic manifestations of LAM is also questioned, especially with the advent of high-resolution CT scanning, the nonspecificity of hormonal receptors with regard to response to therapy, and the possible need for subsequent lung transplantation.