Idiopathic pulmonary fibrosis and pulmonary fibrosis in diffuse systemic sclerosis: two fibroses with different prognoses.

Idiopathic pulmonary fibrosis and diffuse cutaneous systemic sclerosis (dSSc) involve the lung by a fibrotic process. In recent years, there has been increasing awareness that the natural history of these two types of pulmonary fibrosis might be different. The purpose of this study was to compare lung involvement in these two diseases in a prospective fashion in order to address differences in their clinical course. Forty-three consecutive patients, 18 with lone interstitial pulmonary fibrosis (lone IPF) and 25 with dSSc-IPF were evaluated clinically, radiologically and physiologically at the entry into the study and the evolution of their disease was contrasted by survival analysis. Patients with lone IPF compared with dSSc-IPF were characterized by male predominance (p < 0.001), older age at disease onset (p < 0.001), shorter disease duration (p < 0.001), more frequent crackles on auscultation and clubbing (p < 0.001 and p < 0.0001, respectively), more severe dyspnea (p < 0.0001) and more advanced radiological involvement (p < 0.0001). Functional indices presented comparable values and did not reach statistically significant differences except for the values of single breath CO diffusing capacity (p < 0.0001) and the PaO2 (p < 0.01) which was worse in patients with lone IPF. Finally 12 of the 18 patients with lone IPF died in 2.66 +/- 1.18 years from the onset of respiratory symptoms, while none of the dSSc-IPF patients had died 5.6 +/- 4.25 years from the first ever appearance of respiratory involvement (p < 0.001). In conclusion, although the two groups of patients were not at an absolutely comparable stage of their disease, a worse prognosis for patients with lone IPF seems to emerge from this study.

Chronic eosinophilic pneumonia in rheumatoid arthritis.

We report the case of a 47 year old woman with rheumatoid arthritis and infiltrates on chest radiogram. Typical features of eosinophilic pneumonia were detected upon open lung biopsy, probably unrelated to hydroxychloroquine, the only drug administered to the patient. Good response to steroids was obtained. This case brings to light one more example of the rare association between chronic eosinophilic pneumonia and rheumatoid arthritis.

Pulmonary damage due to paraquat poisoning through skin absorption.

A case of recovery from acute respiratory insufficiency due to paraquat is described. A 57-year-old farmer developed breathlessness, high fever and interstitial infiltrates in the upper and middle lung fields few days after percutaneous paraquat poisoning with rapid evolution to pulmonary fibrosis. Anti-inflammatory drugs and antioxidants, were administered to the patient, though with a delay, with some improvement; the patient survived despite residual lung fibrosis. Paraquat lung, as confirmed by this paper, is not invariably fatal.

Brucella haemorrhagic pleural effusion.

Brucella melitensis (BM) is a rare respiratory pathogen. The lungs are usually affected in the subacute and chronic course of the disease, when pleurisy, empyema, hilar adenopathy, pneumonia and lung abscess have been described. We present a patient with BM haemorrhagic pleural effusion, with low pH, low glucose and positive pleural fluid cultures. Brucellosis should be considered in the differential diagnosis of patients with long-standing pleural effusions of unknown aetiology.

Orthodeoxia in amiodarone-induced acute reversible pulmonary damage.

A case of acute reversible pulmonary damage from amiodarone is described. Pulmonary infiltrates had a basal predominance. The histopathologic picture was that of acute alveolitis. Orthodeoxia was evident on blood gas analysis; the PaO2 was 73 mm Hg on recumbency, and the PaO2 was 57 mm Hg in the upright position. Partial arterial resaturation was evident on exercise (PaO2, 64 mm Hg).

Round atelectasis and Metsovo lung.

Round (helical) atelectasis is one of the benign sequelae of occupational asbestos exposure. Environmental asbestos exposure does not differ from occupational in its pleural manifestations, but to our knowledge, round atelectasis has not been reported yet. In the present study, we present the clinical and radiologic findings of five individuals with round atelectasis. They were all born in the Metsovo area, northwest Greece, where environmental exposure to asbestos (tremolite) has been documented. All five had negative evaluation for malignancy. In addition, they have been followed up for one to four years and four of them are in good health, thus confirming round atelectasis as a benign, nonpremalignant condition. The fifth patient died of malignant pleural mesothelioma two years later, while the previously detected round atelectasis remained unchanged. We therefore consider that his mesothelioma was not related to the round atelectasis, although both were certainly related to the same environmental asbestos exposure.