Objective To summarize the clinical characteristics of patients with diffuse parenchymal lung disease (DPLD) combined with hematological diseases in order to improve the clinicians’ knowledge of these diseases. Methods The clinical data of 46 patients was collected, who were hospitalized in Nanjing Drum Tower Hospital from January 2010 to October 2020 for DPLD combined with hematological diseases. Their clinical manifestations, laboratory tests, imaging features, diagnostic methods, treatment and prognosis were analyzed retrospectively. Results Among the 46 patients, there were 26 males and 20 females, with an average age of 60±13 years old. The main symptoms were cough and sputum, dyspnea, fever, chest tightness, and so on. Laboratory tests showed that some patients had pancytopenia or two-line cytopenia, and increase in lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate and β2-microglobulin. Bilateral ground glass opacity, consolidations, big or small nodules, reticular shadows, and traction bronchiectasis were showed on chest high-resolution computed tomography. Among the 13 patients who were diagnosed clearly by pathology, they had 5 cases of organizing pneumonia, 4 cases of pulmonary alveolar proteinosis, 2 cases of acute fibrinous and organizing pneumonia, 1 case of diffuse alveolar hemorrhage, and 1 case of lung amyloidosis. Thirty-three patients were clinically diagnosed, including 3-case drug-induced interstitial lung disease, and 1-case exogenous allergic alveolitis. The patients with diffuse pulmonary lesions as the first manifestation and subsequently diagnosed with hematological diseases accounted for 65.2% (30/46). Among these patients, 2 of them had two kinds of hematological diseases at the same time. In the rest of the 16 cases, hematological diseases were diagnosed before DPLD. Among the 46 cases, 26 patients improved after treatment, 18 of them were treated with glucocorticoid, 8 with N-acetylcysteine and pirfenidone, 4 with granulocyte-macrophage colony stimulating factor inhaling and/ or whole lung alveolar lavage, and 2 with clarithromycin for immune regulation, etc. Fifteen patients refused treatment and transferred back to local hospital after the diagnosis of hematological diseases. Five patients died, 2 of them died of respiratory failure and 3 of them died of diseases progression. Conclusions DPLD includes many kinds of diseases, with known or unknown etiology and lack of specificity in clinical manifestations. Therefore, diagnosis for them is quite difficult. Hematological diseases themselves can be the causes of DPLD. At the same time, the treatment for hematological diseases and the related immunosuppression after treatment can also cause DPLD. In the clinical practice, careful screening and systematic differentiation are urgently needed in order to treat different causes precisely, control the conditions and improve the prognosis.
Objective To summarize the clinical characteristics of pneumocystis pneumonia (PCP) secondary to interstitial lung disease (ILD) to improve the prophylaxis and management level of clinicians. Methods The clinical data of 50 patients with PCP secondary to ILD in the Department of Respiratory and Critical Care Medicine of Nanjing Drum Tower Hospital from January 2015 to December 2022 were collected. SPSS 26.0 software was used for statistical analysis. Results A total of 50 patients with PCP secondary to ILD were screened. Among the 50 patients, there were 23 males and 27 females, with a median age of 64 years old. Forty-eight cases (96%) had a history of glucocorticoid therapy with the median duration of 3 months; 31 (77.5%, 31/40) cases developed PCP in the first 6 months after glucocorticoid therapy; 34 cases had a history of glucocorticoid and immunosuppressants at the same time. None of the 50 ILD patients used drugs for PCP prophylaxis before developing PCP. The major clinical manifestations of PCP secondary to ILD were worse cough and shortness of breath or fever. Laboratory results showed 38 cases (76.0%) had peripheral blood total lymphocyte count <200/µL, 27 cases (54.0%) had CD4+ T cell count <200/µL, 34 cases (68.0%) had CD4+ T cell count <300/µL, 37 cases (74.0%) had CD3+ T cell count <750/µL, 34 cases (68.0%) had β-D-glucan test >200 pg/mL, 35 cases (70.0%) had lactic dehydrogenase > 350 U/L and 41 cases (82.0%) had type Ⅰ respiratory failure. High resolution computed tomography showed added ground-glass opacity and consolidation on the basis of the original ILD. Thirty-six cases were detected the Pneumocystis jirovecii by metagenomic next-generation sequencing with broncho-alveolar lavage fluid as the main source, and 2 cases by smear microscopy. All patients were treated with trimethoprim-sulfamethoxazole. After treatment, 29 cases were discharged with a better health condition, 10 cased died, and 11 cases left hospital voluntarily because of treatment failure or disease deterioration. Conclusions After the use of glucocorticoid and immunosuppressants, ILD patients are susceptible to life-threatening PCP. It is particularly important to make an early diagnosis. Attention should be paid to integrate the symptoms, levels of peripheral blood lymphocyte count, β-D-glucan test, lactic dehydrogenase and imaging findings to make an overall consideration. It is suggested to perform next-generation sequencing with broncho-alveolar lavage fluid at an early stage when patients can tolerate fiberoptic bronchoscopy to avoid misdiagnosis and missed diagnosis. ILD patients often develop PCP in the first 6 months after using glucocorticoid and immunosuppressants. During follow-up, peripheral blood CD4+ and CD3+ T cell count should regularly be monitored so as to timely prevent PCP.
ObjectivesTo compare the clinical features of combined pulmonary fibrosis and emphysema (CPFE) and idiopathic pulmonary fibrosis (IPF).MethodsEighty-three patients diagnosed as CPFE or IPF for the first time were retrospectively analyzed from June 2014 to July 2018 in Nanjing Drum Tower Hospital, including 47 patients in the CPFE group and 36 in the IPF group. The demographic characteristics, clinical manifestations, pulmonary function, cardiac ultrasound, blood gas analysis and prognosis of the two groups were compared.ResultsThe proportion of smokers in the CPFE group was higher than IPF group (P<0.05), but dyspnea was lower (P<0.05). The FVC, FVC%pred, FEV1, FEV1%pred and VC% of the CPFE group were higher than IPF group (P<0.05), while FEV1/FVC%pred in the IPF group was higher than CPFE group (P<0.05). DLCO/VA%pred of CPFE group decreased more significantly than IPF group (P<0.05), RV/TLC%pred of CPFE group increased annually, while decreased annually in IPF group (P<0.01). The RV%pred of CPFE increased annually, while that of IPF group decreased annually (P<0.05). There was no significant difference in arterial oxygen pressure and pulmonary artery pressure between the two groups. As for prognosis, the 1- and 3-year survival rate of the CPFE group were 87.9% and 73.8% respectively, those of the IPF group were 84.1% and 65.8% respectively, and no significantly difference was observed between two groups (P=0.95).ConclusionsCompared with IPF, patients with CPFE usually have more smokers, less proportion of dyspnea, almost normal lung volume, more rapidly decreased DLCO/VA%pred, and no significant difference in prognosis.
ObjectiveTo improve the understanding of psittacosis, the clinical data of 8 cases are reviewed. The application of pathogen metagenomics next-generation sequencing (mNGS) in the diagnosis of nocardiosis is also investigated.MethodsThe clinical data of eight patients with psittacosis diagnosed by mNGS in Nanjing Drum Tower Hospital from January 2018 to May 2020 were reviewed. The clinical characteristics, laboratory examination characteristics and imaging changes were analyzed, and the treatment outcome was followed-up.ResultsAmong the eight cases, there were six males and two females, aged 43～83 years old, with an average age of 64±12 years old. Six of them had a clear history of poultry exposure. The major clinical manifestations were fever, cough, dyspnea, etc. Chest high-resolution computed tomography (HRCT) may have solid shadow, ground glass like shadow. Chlamydia psittaci was detected by mNGS in eight patients’ bronchoalveolar lavage fluid. Minocycline or moxifloxacin were administrated, six patients were discharged after their condition improved, and two patients died.ConclusionsThe incidence of psittacosis is low, and its clinical manifestations lack specificity. In the course of the disease, there may be different degrees of fever, cough, sputum, dyspnea and other symptoms. The lungs can be heard with wet rales, chest HRCT can be seen ground glass shadow, consolidation shadow, accompanied by air bronchogram. Chlamydia psittaci can be detected in alveolar lavage fluid by mNGS. The patients need to be treated for a long time, lasting at least 10 to 14 days. Tetracycline drugs should be the first choice, and can be combined with other antibiotics with activity against gram-positive and gram-negative bacteria in critical patients.