Pneumonic infiltration

In summary, dielectric properties differ between healthy and injured lungs due to atelectasis caused by mechanical ventilation. It is shown that detection of more or less collapsed lung tissue was possible by analysing differences in electrical impedanceat different frequencies. This can be a promising feature for multi-frequency BIT devices. More studies are needed to evaluate additional diseases, such as pulmonary edema or pneumonic infiltrates. 

The third condition, late respiratory systemic syndrome, is characterized by cough, mucus production, occasional wheezing, and systemic symptoms of malaise, chills, fever, and aching muscles and joints, occurring 4—12 hours alter exposure. This syndrome also has been termed TMA flu and clinically resembles hypersensitivity pneumonitis with visible chest X-ray infiltrates. High levels of IgG serum antibody and total serum antibody directed against trimellityl-human protein conjugates accompany the syndrome, and a latent period of exposure before the onset of symptoms is typical. 

Hypersensitivity Anaphylactoid purpura, anaphylaxis, angioneurotic edema, myocarditis, pericarditis, polyarthralgia, pulmonary infiltrates with eosinophilia, systemic lupus erythematous exacerbation, urticaria hypersensitivity syndrome (cutaneous reaction, eosinophilia, and one or more of the following Hepatitis, pneumonitis, nephritis, myocarditis, pericarditis, fever, lymphadenopathy). Muscuioskeietai - ArVr ra g a, arthritis, bone discoloration, joint stiffness and swelling, myalgia, polyarthralgia. 

Capsules/Tablets/Oral solution - Pulmonary symptoms, including dyspnea, pulmonary infiltrates, pneumonitis, and pneumonia have been reported during therapy with ribavirin and interferon. Occasional cases of fatal pneumonia have occurred. In addition, sarcoidosis or the exacerbation of sarcoidosis has been reported. 

Pulmonary - Pulmonary symptoms (especially a dry, nonproductive cough) or a nonspecific pneumonitis indicate a potentially dangerous lesion and require interruption of treatment and careful investigation. The typical patient presents with fever, cough, dyspnea, hypoxemia, and an infiltrate on chest x-ray. 

Puimonary disorders Dyspnea, pulmonary infiltrates, pneumonia, bronchiolitis obliterans, interstitial pneumonitis, and sarcoidosis, some resulting in respiratory failure and/or patient deaths, may be induced or aggravated by peginterferon alfa-2a or alpha interferon therapy. 

Infrequent reactions to interferon therapy include proteinuria, renal toxicity, autoimmune disease, thyroid disease, ophthalmic toxicity, pulmonary dysfunction (pulmonary infiltrates, pneumonitis, and pneumonia), and cardiovascular effects (tachycardia, arrhythmia, hypotension, cardiomyopathy, and myocardial infarction). Rarely, the body may develop antibodies against interferons that inhibit their effectiveness. 

Pulmonary toxicity is dose-limiting for bleomycin and usually presents as pneumonitis with cough, dyspnea, dry inspiratory crackles on physical examination, and infiltrates on chest x-ray. The incidence of this adverse event is increased in patients older than 70 years of age and with cumulative doses greater than 400 units. In rare cases, pulmonary toxicity can be fatal. Other toxicities are listed in Table 55-4. 

A chest X-ray showed diffuse interstitial and alveolar infiltrates and small bilateral pleural effusions. A high-resolution CT scan of the chest showed diffuse ground-glass attenuation and patchy peripheral opacities, consistent with an acute hypersensitivity pneumonitis, and other diagnoses were ruled out. He responded to gluco-corticoids. 

There have been two reports of micronodular pulmonary infiltrates (BCG pneumonitis) associated with fever, chills, and night sweats following multiple instillations of intravesical BCG (39). Both patients were 71 years old. The reactions, including radiographic infiltrates, resolved spontaneously or after steroid therapy. 

A 53-year-old Japanese man, who had taken skullcap intermittently for hemorrhoids, developed recurrent interstitial pneumonitis (17). Re-challenge, after he had stopped taking the herbal remedy and had become symptom free, resulted in a high fever and signs and symptoms of interstitial pneumonitis. Transbronchial lung biopsy showed Ijmphocytic alveolitis with eosinophilic infiltration. The symptoms subsided again after withdrawal. 

In patients with definite or probable methotrexate-induced lung injury, the predominant clinical features include shortness of breath, cough, and fever (13). Pathological examination usually shows an interstitial inflammatory cell infiltrate (sometimes granulomatous or with alveolar damage), and variable degrees of interstitial fibrosis. Unfortunately, confirmatory evidence is sometimes hard to obtain, particularly in patients with rheumatoid arthritis in whom rheumatoid interstitial lung disease can also occur. Infectious pneumonias, particularly viral or Pneumocystis jiroveci pneumonia, which resemble methotrexate pneumonitis and can occur as a result of immunosuppression, should also be carefully excluded. 

Biopsy-proven mitomycin pneumonitis occurred in five of 44 patients who were given mitomycin in conjunction with low-dose doxorubicin 20 mg/week (1). The picture was of pulmonary infiltrates clinically and radiologically, progressive dyspnea, and hypoxia, and improvement with glucocorticoids. The mean total dose of mitomycin that had been given in the five patients was 89 mg. Mitomycin-induced interstitial pneumonitis occurs in 2-38% of cases (2,3) and at cumulative doses of 20 mg/m or greater, although doses up to 30 mg/m have been used safely. It is characteristically of slow-onset (3). 

Allergic pneumonitis and transient eosinophihc pulmonary infiltrate (Loeffler s syndrome) are rare. These syndromes have also been observed with peniciUin hypersensitivity (14-16). In one case, an alveolar allergic reaction, probably due to ampicillin, showed features of an adult respiratory distress syndrome (17). 

Interstitial pneumonitis is extremely rare with phenytoin (11). The clinical features are fever, dyspnea, hypoxemia, and bilateral radiographic infiltrates. It responds to... 

A 62-year-old woman with severe asthma took oral pranlukast 450 mg/day and oral prednisolone 80 mg/day for a severe asthmatic attack. After oral prednisolone was tapered and subsequently withdrawn by day 35, she was maintained on pranlukast only and 5 days later had fever, deteriorating pulmonary symptoms, hypoxemia, and bibasal reticulonodular pulmonary infiltrates on chest CT. A transbronchial biopsy was consistent with drug-related interstitial pneumonitis. A lymphocyte stimulation test was positive for pranlukast. Her fever abated and her pulmonary symptoms markedly improved 3 days after withdrawal of pranlukast, and 5 months later the pulmonary infiltrates had completely resolved. 

Cases of allergic pneumonitis and pulmonary infiltrates with eosinophilia have been described with co-trimoxa-zole (23). Such reactions have not been reported with trimethoprim alone. Pulmonary infiltrates due to co-tri-moxazole hypersensitivity in patients with AIDS are particularly worrisome, since they mimic progression of underlying opportunistic pulmonary infections. 

Denis, M., Cornier, Y. and Laviolette, M. (1992). Murine hypersensitivity pneumonitis a study of cellular infiltrates and cytokine production and its modulation by cyclosporin A. Am, J. Respir. Cell. Mol. Biol. 6, 68-74. 

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