Acute interstitial pneumonia

Acute interstitial pneumonia or diffuse alveolar damage in the context of other manifestations of overdose has been described (SEDA-22, 84). 

In Japan, acute interstitial pneumonia due to lefluno-mide has been mentioned as a serious and severe adverse effect, with an incidence of 1.1% and a fatal outcome in 0.36% (57-59). 

Kamata Y, Nara H, Kamimura T, Haneda K, Iwamoto M, Masuyama J, Okazaki H, Minota S. Rheumatoid arthritis complicated with acute interstitial pneumonia induced by leflunomide as an adverse reaction. Intern Med 2004 43(12) 1201. ... 

Takeishi M, Akiyama Y, Akiba H, Adachi D, Hirano M, Mimura T. Leflunomide induced acute interstitial pneumonia. J Rheumatol 2005 32(6) 1160-3. 

Melphalan can cause an acute interstitial pneumonia with hypoxemia (3). This is probably due to a hypersensitivity mechanism and should be distinguished from fibrosing pneumonitis, which melphalan can also cause (4). 

Takahashi N, Iwanaga T, Aizawa H, Koto H, Watanabe K, Kishikawa R, Ikeda T, Shoji S, Nishima S, Hara N. Acute interstitial pneumonia induced by ONO-1078 (pranlukast), a leukotriene receptor antagonist. Intern Med 200I 40(8) 79I. ... 

Respiratory Bronchiolitis-Associated Interstitial Lung Disease 341 Desquamative Interstitial Pneumonia 341 Lymphoid Interstitial Pneumonia 342 Acute Interstitial Pneumonia 342 Sarcoidosis 343 Miscellaneous Rare Forms of Interstitial Lung Disease of Unknown Etiology 345 Pulmonary Langerhans Cell Histiocytosis 345 Lymphangioleiomyomatosis 345 Eosinophilic Pneumonia 346 Pulmonary Alveolar Proteinosis 348 Pulmonary Microlithiasis 348... 

The term idiopathic interstitial pneumonias refers to a group of seven entities with distinct histologic patterns idiopathic pulmonary fibrosis (IFF), characterized by the pattern of usual interstitial pneumonia (UIP) nonspecific interstitial pneumonia (NSIP) cryptogenic organizing pneumonia (COP) respiratory bron-chiohtis-associated interstitial lung disease (RB-ILD) desquamative interstitial pneumonia (DIP) lymphoid interstitial pneumonia (LIP) and acute interstitial pneumonia (AIP). 

Fig. 26.12a,b. Acute interstitial pneumonia (AIP) in a 58-year-old patient, a Axial CT image shows bilateral ground-glass opacities in a geographic distribution (arrow). Consolidation is seen in the more dependent lung (arrowheads). Small, coexisting bilateral pleural effusions are present, b (see next page)... 

Usual interstitial pneumonia Nonspecific interstitial pneumonia Organizing pneumonia Diffuse alveolar damage Respiratory bronchiolitis Desquamative interstitial pneumonia Lymphocytic interstitial pneumonia Idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis Nonspecific interstitial pneumonia (provisional) Cryptogenic organizing pneumonia Acute interstitial pneumonia Respiratory bronchiolitis-associated interstitial lung disease Desquamative interstitial pneumonia Lymphocytic interstitial pneumonia... 

Abbreviations-. HRCT, high-resolution computed tomography AIP, acute interstitial pneumonia. 

Figure 7 HRCT images demonstrating diffuse patchy involvement of ground glass opacities, consolidation, and reticulation in a patient with AIP. Abbreviations HRCT, high-resolution computed tomography AIP, acute interstitial pneumonia.

Acute interstitial pneumonia is simply idiopathic acute respiratory distress syndrome (ARDS) (26,27). As such, it should be regarded by the pathologist as a clinical diagnosis. 

Silva Cl, Churg A, Muller NL. Hypersensitivity pneumonitis spectrum of high-resolution CT and pathologic findings. AJR Am J Roentgenol 2007 188 334-344. Vourlekis JS. Acute interstitial pneumonia. Clin Chest Med 2004 25 739-747. Bouros D, Nicholson AC, Polychronopoulos V, et al. Acute interstitial pneumonia. Eur Respir J 2000 15 412 18. 

Acute exacerbations of IPF are characterized by rapid development of cough, dyspnea, hypoxemia, and worsening pulmonary infiltrates in patients with known IPF (29,148-151). Presentation is similar to acute respiratory distress syndrome (ARDS) (29,148,149,151,152). The cardinal histological feature is DAD superimposed on a background of UIP (149,151). Idiopathic acute interstitial pneumonia (AIP) (28,152) exhibits similar clinical and histological features as acute exacerbations of IPF, but lacks the requisite features of UIP. High-dose intravenous (IV) pulse methylprednisolone has been used to treat acute exacerbations of IPF, but data on treatment are limited to anecdotal cases and small series (29,148,149,151). This entity is reviewed in chapter 15 and will not be further discussed here. 

Swigris JJ, Brown KK. Acute interstitial pneumonia and acute exacerbations of idiopathic pulmonary fibrosis. Senun Respir Crit Care Med 2006 27(6) 659-667. 

Suh GY, Kang EH, Chung MP, et al. Early intervention can improve clinical outcome of acute interstitial pneumonia. Chest 2006 129(3) 753-761. 

Figure 2 CT scan of a patient with biopsy-proven acute interstitial pneumonitis showing diffuse ground-glass infiltrate in both lungs. The pattern of abnormality is typical but not diagnostic of acute interstitial pneumonia.

Katzenstein ALA, Myers JL, Mazur MT. Acute interstitial pneumonia a clin-icopathologic, ultrastmctural, and cell kinetic study. Am J Surg Pathol 1986 10(4) ... 

Askin FB. Back to the future the Hamman-Rich syndrome and acute interstitial pneumonia. Mayo Clin Proc 1990 65(12) 1624—1626. 

Robinson DS, Geddes DM, HanseU DM, et al. Partial resolution of acute interstitial pneumonia in native lung after single lung transplantation. Thorax 1996 51(11) 1158-1159. 

Primack SL, Hartman TE, Ikezoe J, et al. Acute interstitial Pneumonia radiographic and CT findings in nine patients. Radiology 1993 188(3) 817-820. 

Johkoh T, Muller NL, Taniguchi H, et al. Acute interstitial pneumonia thin-section CT findings in 36 Patients. Radiology 1999 211(3) 859-863. 

Kreidstein SH, L3dwyn A, Keystone EC. Takayasu arteritis with acute interstitial pneumonia and coronary vascuhtis expanding the spectrum. Arthritis Rheum 1993 36(8) 1175-1178. 

Akikusa B, Kondo Y, Irabu N, et al. Six cases of microscopic polyarteritis exhibiting acute interstitial pneumonia. Pathol Int 1995 45(8) 580-588. 

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