Familial interstitial lung disease in two young Korean sisters

Abstract

Most of the interstitial lung diseases are rare, chronic, progressive and fatal disorders, especially in familial form. The etiology of the majority of interstitial lung disease is still unknown. Host susceptibility, genetic and environmental factors may influence clinical expression of each disease. With familial interstitial lung diseases, mutations of surfactant protein B and surfactant protein C or other additional genetic mechanisms (e.g. mutation of the gene for ATP-binding cassette transporter A3) could be associated. We found a 21 month-old girl with respiratory symptoms, abnormal radiographic findings and abnormal open lung biopsy findings compatible with nonspecific interstitial pneumonitis that is similar to those of her older sister died from this disease. We performed genetic studies of the patient and her parents, but we could not find any mutation in our case. High-dose intravenous methylprednisolone and oral hydroxychloroquine were administered and she is still alive without progression during 21 months of follow-up.

Fig. 1

Computed tomography (CT) scans of the patient (A) and the patient's sister (B), showing diffuse fibrosis and subpleural consolidations in both lungs.

Fig. 2

Interstitial pneumonia with lymphoplasmacytic infiltration and variable amount of collagen fibrosis resulted in the thickening of the interstitium. Most alveoli also show variable amount of intra-alveolar macrophage accumulation and hyperplasia of the alveolar pneumocytes. (A) Hematoxylin-eosin stain, ×100, (B) Masson's trichrome stain, ×100.