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A New Variant of Combined Pulmonary Fibrosis and Emphysema From Second-Hand Smoke: A Case Report and Review of Literature.

Khan R, Tulpule S, Iroka N, Sen S, Mathew T, Islam M, Yousif A, Longo S - J Clin Med Res (2015)

Bottom Line: Patients presenting with such findings are usually found to be heavy smokers or former smokers.No prior research has presented a documented case of such a fatal condition in a young person with no prior history of smoking.As most published studies have attributed these findings as a secondary response to a history of smoking, other etiologies and risk factors have yet to be properly analyzed resulting in prolonged hospital course and often missed diagnoses.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department, Raritan Bay Medical Center, 530 New Brunswick Ave., Perth Amboy, NJ 07733, USA.

ABSTRACT
The findings of combined pulmonary fibrosis along with emphysema have been increasingly recognized in the medical literature. Patients presenting with such findings are usually found to be heavy smokers or former smokers. Their presentations begin with severe respiratory distress that gets progressively worse. They are found to have low diffusion capacity (DLCO) although spirometry will show preserved lung volumes. No prior research has presented a documented case of such a fatal condition in a young person with no prior history of smoking. In this case report, we discuss the presentation, diagnosis, and management of a young 29-year-old non-smoker with increasing shortness of breath with a complicated hospital course discovered to have an abnormal variant or presentation of "combined pulmonary fibrosis and emphysema" (CPFE). As most published studies have attributed these findings as a secondary response to a history of smoking, other etiologies and risk factors have yet to be properly analyzed resulting in prolonged hospital course and often missed diagnoses.

No MeSH data available.


Related in: MedlinePlus

Chest CT without contrast: consolidative changes of lower lobes.
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Figure 2: Chest CT without contrast: consolidative changes of lower lobes.

Mentions: The patient was admitted to telemetry for the management of pneumonia with azithromycin and ceftriaxone initially. Patient was found to be positive for Mycoplasma pneumonia and medications were adjusted accordingly. Patient continued to have persistent hypoxia and continued to desaturate to 88% upon ambulation. She was later found to have hemophilus influenza growth in sputum culture, which was properly being managed by her antibiotic regimen. During her hospital stay, although the patient was receiving solumedrol and antibiotics she continued to have diffuse bilateral crackles and productive cough. Patient was found to have leukocytosis as high as 19.6, but this could be attributed to her steroid treatment. However, this train of thought remained unclear as the patient was also found to have a bandemia of 21. Her antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) were adjusted to consist of doxycycline, zyvox, and fluconazole. The patient continued to deteriorate and systemic workup including allergy test, antineutrophil cytoplasmic autoantibody (cANCA), perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), antinuclear antibody (ANA), purified protein derivative (PPD), QuantiFERON, and human immunodeficiency virus (HIV) test was all conducted. Full systemic workup returned negative for any findings. After completing her course of antibiotics, she was also removed from her steroids but would continue to desaturate and lung findings remained unchanged. Patient underwent bronchoscopy but no significant mass or lesion was found to biopsy and her postoperative diagnosis remained as non-resolving pneumonia. Repeat CT scan was performed which showed minimal improvement and continue to suggest pneumonia and possibly underlying interstitial lung disease (Fig. 2).


A New Variant of Combined Pulmonary Fibrosis and Emphysema From Second-Hand Smoke: A Case Report and Review of Literature.

Khan R, Tulpule S, Iroka N, Sen S, Mathew T, Islam M, Yousif A, Longo S - J Clin Med Res (2015)

Chest CT without contrast: consolidative changes of lower lobes.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554223&req=5

Figure 2: Chest CT without contrast: consolidative changes of lower lobes.
Mentions: The patient was admitted to telemetry for the management of pneumonia with azithromycin and ceftriaxone initially. Patient was found to be positive for Mycoplasma pneumonia and medications were adjusted accordingly. Patient continued to have persistent hypoxia and continued to desaturate to 88% upon ambulation. She was later found to have hemophilus influenza growth in sputum culture, which was properly being managed by her antibiotic regimen. During her hospital stay, although the patient was receiving solumedrol and antibiotics she continued to have diffuse bilateral crackles and productive cough. Patient was found to have leukocytosis as high as 19.6, but this could be attributed to her steroid treatment. However, this train of thought remained unclear as the patient was also found to have a bandemia of 21. Her antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) were adjusted to consist of doxycycline, zyvox, and fluconazole. The patient continued to deteriorate and systemic workup including allergy test, antineutrophil cytoplasmic autoantibody (cANCA), perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), antinuclear antibody (ANA), purified protein derivative (PPD), QuantiFERON, and human immunodeficiency virus (HIV) test was all conducted. Full systemic workup returned negative for any findings. After completing her course of antibiotics, she was also removed from her steroids but would continue to desaturate and lung findings remained unchanged. Patient underwent bronchoscopy but no significant mass or lesion was found to biopsy and her postoperative diagnosis remained as non-resolving pneumonia. Repeat CT scan was performed which showed minimal improvement and continue to suggest pneumonia and possibly underlying interstitial lung disease (Fig. 2).

Bottom Line: Patients presenting with such findings are usually found to be heavy smokers or former smokers.No prior research has presented a documented case of such a fatal condition in a young person with no prior history of smoking.As most published studies have attributed these findings as a secondary response to a history of smoking, other etiologies and risk factors have yet to be properly analyzed resulting in prolonged hospital course and often missed diagnoses.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department, Raritan Bay Medical Center, 530 New Brunswick Ave., Perth Amboy, NJ 07733, USA.

ABSTRACT
The findings of combined pulmonary fibrosis along with emphysema have been increasingly recognized in the medical literature. Patients presenting with such findings are usually found to be heavy smokers or former smokers. Their presentations begin with severe respiratory distress that gets progressively worse. They are found to have low diffusion capacity (DLCO) although spirometry will show preserved lung volumes. No prior research has presented a documented case of such a fatal condition in a young person with no prior history of smoking. In this case report, we discuss the presentation, diagnosis, and management of a young 29-year-old non-smoker with increasing shortness of breath with a complicated hospital course discovered to have an abnormal variant or presentation of "combined pulmonary fibrosis and emphysema" (CPFE). As most published studies have attributed these findings as a secondary response to a history of smoking, other etiologies and risk factors have yet to be properly analyzed resulting in prolonged hospital course and often missed diagnoses.

No MeSH data available.


Related in: MedlinePlus