SUCCESSFULLY TREATED ACUTE INTERSTITIAL PNEUMONIA

Abstract

Acute interstitial pneumonia (AIP) is a rare idiopathic interstitial pneumonia with histology finding of diffuse alveolar damage (DAD). It is characterized by progressive hypoxic respiratory failure, high mortality rate, and absence of guidelines for its treatment. Here we present a case of a 64-year-old woman with progressive dyspnea, acute respiratory failure, diffuse bilateral reticulonodular opacities on standard chest radiograph, diffuse ground-glass opacities on computed tomography, and biopsy proven DAD. Diagnosis of AIP was established after extensive work-up that excluded the known risk factors for acute respiratory distress syndrome. Oxygen therapy and high-dose parenteral corticosteroids led to gradual improvement and resulted in complete respiratory recovery. Since there are no existing guidelines for treating AIP, more case reports and case series if not randomized control trials are warranted in order to define the most effective therapeutic modality.

Keywords: Acute interstitial pneumonia; Acute respiratory distress syndrome; Corticosteroid therapy; High-flow nasal cannula.

Fig. 1

Chest x-ray taken at presentation.

Fig. 2

High-resolution computer tomography at presentation: (a) and (b) slices of upper lung parts; (c) and (d) slices of middle and lower lung parts, respectively.

Fig. 3

Bronchoscopy sample: (A) HEx100; and (B)) HEx400: compressed alveoli with lymphocytic infiltrate in thickened septa and hyalinized fibrotic stroma.

Fig. 4

Chest x-ray taken after full recovery.