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Clinico-pathological analysis referring hemeoxygenase-1 in acute fibrinous and organizing pneumonia patients.

Hara Y, Shinkai M, Kanoh S, Kawana A, Rubin BK, Matsubara O, Kaneko T - Respir Med Case Rep (2015)

Bottom Line: The characteristic radiographic findings were bilateral consolidations and ground glass opacities.Lung biopsy specimens revealed fibrin balls and alveolitis with abundant cellular HO-1 expression.Steroid response was excellent and the pulmonary involvements absolutely disappeared for about 3 months.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan ; Respiratory Disease Center, Yokohama City University Medical Center, Kanagawa, Japan.

ABSTRACT
Acute fibrinous and organizing pneumonia (AFOP) is a very rare pathological entity of lung injury characterized by intra-alveolar fibrin balls. Hemeoxygenase (HO) -1 is a cytoprotective enzyme against oxidative stress and inflammation. It is known to be expressed in the alveolar macrophages in the healthy adults and overexpressed in other various lung cells of the lung injury patients. We experienced two cases of subacute form AFOP for these 10 years and reviewed clinico-pathological characteristics. The average age was 62 years old and both were male. The etiology of both cases was idiopathic. The average PaO2/FIO2 ratio was 274.5 ± 84.1. The average levels of C-reactive protein and surfactant protein - A of the serum were elevated to 19.8 ± 6.3 mg/dL and 67.6 ± 15.8 ng/mL, respectively. Serum sialylated carbohydrate antigen levels were normal in both cases. The characteristic radiographic findings were bilateral consolidations and ground glass opacities. Lung biopsy specimens revealed fibrin balls and alveolitis with abundant cellular HO-1 expression. Steroid response was excellent and the pulmonary involvements absolutely disappeared for about 3 months.

No MeSH data available.


Related in: MedlinePlus

High resolution computed tomography revealed air space consolidation intermingled groung glass opacities in the upper and middle lobes in the right lung (A: case 1) and bilateral patchy consolidation and diffuse small nodules (B: case 2).
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fig1: High resolution computed tomography revealed air space consolidation intermingled groung glass opacities in the upper and middle lobes in the right lung (A: case 1) and bilateral patchy consolidation and diffuse small nodules (B: case 2).

Mentions: A 70-year-old man had complained of fever and dry cough for one week. The chest radiograph at his first visit showed right upper lobe opacity. He developed dyspnea and was admitted to our hospital one week later with tachypnea and fever. Fine crackles were heard in the right chest. White blood cell counts (WBC) was 18700/μL (normal: 4000–8000/μL), C-reactive protein (CRP) was 24.2 mg/dL (normal: ≦0.3 mg/dL). Brain natriuretic peptide, antineutrophil cytoplasmic antibodies (ANCA) and antinuclear antibody (ANA) were normal. Urine antigen testing for Legionella and Streptococcus pneumoniae was negative. Blood gas analysis (BGA) showed hypoxemia with pH 7.43, PaCO2 34 mmHg and PaO2 62 mmHg with oxygen supplementation (2 L) by nasal cannula. High-resolution computed tomography (HRCT) showed ground glass opacities (GGO) in the subpleural upper lobe. His symptoms progressed over a week despite oxygen and antibiotics and repeat HRCT showed air space consolidation with GGO in the right upper and middle lobes with some GGO in the left lung as well (Fig. 1A). The bronchoalveolar lavage fluid (BALF) had a total cell count of 8.4 × 105/mL, with 9% macrophages, 16% lymphocytes, 1% eosinophils, 74% neutrophils and CD4/8 ratio of 1.93. Cytomegalovirus and Pneumocystis jeroveci were negative by polymerase chain reaction (PCR). Transbronchial lung biopsy (TBLB) specimens showed numerous fibrin balls and hyperplasia of type II pneumocytes. Eosinophils, hyaline membranes, and hemosiderin-laden macrophages were absent. Immunohistochemistry of biposy specimens using anti-HO-1 antibody confirmed increased HO-1 in the macrophages within fibrin balls and alveolar walls around fibrin balls (Fig. 2A). Methylpredonisolone pulse therapy was given, 1000 mg/day for 3 days, followed by oral prednisolone (0.5 mg/kg). After two weeks, his symptoms and chest radiograph dramatically improved and pulmonary involvements absolutely disappeared after about 3.7 months without relapse.


Clinico-pathological analysis referring hemeoxygenase-1 in acute fibrinous and organizing pneumonia patients.

Hara Y, Shinkai M, Kanoh S, Kawana A, Rubin BK, Matsubara O, Kaneko T - Respir Med Case Rep (2015)

High resolution computed tomography revealed air space consolidation intermingled groung glass opacities in the upper and middle lobes in the right lung (A: case 1) and bilateral patchy consolidation and diffuse small nodules (B: case 2).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356040&req=5

fig1: High resolution computed tomography revealed air space consolidation intermingled groung glass opacities in the upper and middle lobes in the right lung (A: case 1) and bilateral patchy consolidation and diffuse small nodules (B: case 2).
Mentions: A 70-year-old man had complained of fever and dry cough for one week. The chest radiograph at his first visit showed right upper lobe opacity. He developed dyspnea and was admitted to our hospital one week later with tachypnea and fever. Fine crackles were heard in the right chest. White blood cell counts (WBC) was 18700/μL (normal: 4000–8000/μL), C-reactive protein (CRP) was 24.2 mg/dL (normal: ≦0.3 mg/dL). Brain natriuretic peptide, antineutrophil cytoplasmic antibodies (ANCA) and antinuclear antibody (ANA) were normal. Urine antigen testing for Legionella and Streptococcus pneumoniae was negative. Blood gas analysis (BGA) showed hypoxemia with pH 7.43, PaCO2 34 mmHg and PaO2 62 mmHg with oxygen supplementation (2 L) by nasal cannula. High-resolution computed tomography (HRCT) showed ground glass opacities (GGO) in the subpleural upper lobe. His symptoms progressed over a week despite oxygen and antibiotics and repeat HRCT showed air space consolidation with GGO in the right upper and middle lobes with some GGO in the left lung as well (Fig. 1A). The bronchoalveolar lavage fluid (BALF) had a total cell count of 8.4 × 105/mL, with 9% macrophages, 16% lymphocytes, 1% eosinophils, 74% neutrophils and CD4/8 ratio of 1.93. Cytomegalovirus and Pneumocystis jeroveci were negative by polymerase chain reaction (PCR). Transbronchial lung biopsy (TBLB) specimens showed numerous fibrin balls and hyperplasia of type II pneumocytes. Eosinophils, hyaline membranes, and hemosiderin-laden macrophages were absent. Immunohistochemistry of biposy specimens using anti-HO-1 antibody confirmed increased HO-1 in the macrophages within fibrin balls and alveolar walls around fibrin balls (Fig. 2A). Methylpredonisolone pulse therapy was given, 1000 mg/day for 3 days, followed by oral prednisolone (0.5 mg/kg). After two weeks, his symptoms and chest radiograph dramatically improved and pulmonary involvements absolutely disappeared after about 3.7 months without relapse.

Bottom Line: The characteristic radiographic findings were bilateral consolidations and ground glass opacities.Lung biopsy specimens revealed fibrin balls and alveolitis with abundant cellular HO-1 expression.Steroid response was excellent and the pulmonary involvements absolutely disappeared for about 3 months.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan ; Respiratory Disease Center, Yokohama City University Medical Center, Kanagawa, Japan.

ABSTRACT
Acute fibrinous and organizing pneumonia (AFOP) is a very rare pathological entity of lung injury characterized by intra-alveolar fibrin balls. Hemeoxygenase (HO) -1 is a cytoprotective enzyme against oxidative stress and inflammation. It is known to be expressed in the alveolar macrophages in the healthy adults and overexpressed in other various lung cells of the lung injury patients. We experienced two cases of subacute form AFOP for these 10 years and reviewed clinico-pathological characteristics. The average age was 62 years old and both were male. The etiology of both cases was idiopathic. The average PaO2/FIO2 ratio was 274.5 ± 84.1. The average levels of C-reactive protein and surfactant protein - A of the serum were elevated to 19.8 ± 6.3 mg/dL and 67.6 ± 15.8 ng/mL, respectively. Serum sialylated carbohydrate antigen levels were normal in both cases. The characteristic radiographic findings were bilateral consolidations and ground glass opacities. Lung biopsy specimens revealed fibrin balls and alveolitis with abundant cellular HO-1 expression. Steroid response was excellent and the pulmonary involvements absolutely disappeared for about 3 months.

No MeSH data available.


Related in: MedlinePlus