• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.843-849
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• 1999

The prevalence of nonspecific interstitial pneumonitis(NSIP) in HIV-positive patients with pulmonary disease has varied from 11 to 38%. But NSIP in HIV-positive patients is indistinguishable from Pneumocystis carinii pneumonia(PCP) clinically and radiologically. The number of HIV-positive patients is less in Korea than in western developed countries, so little attention has been paid to the differential diagnosis between NSIP and PCP. We report a case of NSIP in HIV-positive, 61-year-old man which mimicked PCP. He presented with cough, sputum and mild exertional dyspnea. Lung sound was clear. But, chest X-ray and HRCT demonstrated diffuse patch and bilateral ground-glass opacities in central and perihilar area of both lung. Microbial pathogens were not found on sputum, BAL fluid and tissues taken by TBLB. In transbronchial lung biopsy specimen, interstitial infiltrates with lymphocytes were distributed on peribronchiolar regions. A pathologic diagnosis of NSIP was suggested, he received symptomatic treatment. The follow-up chest X-ray showed near complete resolution.

• Tuberculosis and Respiratory Diseases
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• v.53 no.2
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• pp.136-147
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• 2002

Background : Interstitial lung disease has various manifestations that are differentiated by their pathology, progress and treatment. However, all manifestations eventually progresses to pulmonary fibrosis. Recent studies have shown that apoptosis of pulmonary epithelial cells might be related to pulmonary fibrosis. The correlation of the apoptotic index with the clinical manifestations, pathological findings, HRCT findings and the response to treatment were examined. Materials and Methods : Twenty subjects (14 men, 16 women), who had been diagnosed with interstitial lung disease through an open lung biopsy, were enrolled in this study. The subtypes were one AIP, two NIP, eight BOOP, and seven UIP cases. The apoptotic index was scaled from 0-2 depending on the fraction of positive staining cells by TUNEL method. The clinical severity was assessed by a modification of a previously developed CRP scoring system. The pathologic scores were based on 4 components: fibrosis, cellularity, desquamation, and granulation. In the HRCT study, each lobe was scored by the radiologists on a scale for both fibrosis and ground-glass attenuation. The treatment response was assessed by an increase in more than 10% of the CRP score, and comparing the results 3 months before and after treatment. Results : The apoptotic index showed no correlation with the CRP and HRCT scoring system. The apoptotic index correlated with the pathologic elements including fibrosis, cellularity and the desquamation score (p<0.05). Of the 16 patients who received corticosteroid therapy, 9 patients (56.3%) responded to therapy. There was no correlation between the response to corticosteroid and the apoptotic index. In the case of patients with acute and subacute ILD, the apoptotic index showed a correlation with the cellularity, desquamation, and the total histological score (p<0.05). In the case of patients with chronic ILD, the apoptotic index correlated with the fibrosis and cellularity score (p<0.05). Conclusion : Apoptosis of the pulmonary epithelial cells is implicated in the pathogenesis of interstitial lung disease particularly on a pathological basis.

• Clinical and Experimental Pediatrics
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• v.45 no.4
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• pp.529-534
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• 2002

Interstitial pneumonia is a heterogenous group of inflammatory and fibrosing lesions that manifest themselves as infiltrative lung disease. Of these, nonspecific interstitial pneumonia is characterized as a variable degree of interstitial inflammation with or without fibrosis and is distinguished from usual interstitial pneumonia and desquamative interstitial pneumonia, histologically. The influx of inflammatory cells and the responses of immune effector cells injury to the alveolar wall and these initial injuries results in alveolitis and fibrosis. Consequently, the gas exchange throughout the alveolar wall is impaired and the patients suffer from lung diseases of a restrictive pattern. The chief complaints represented are dyspnea and dry cough. We experienced a case of nonspecific interstitial pneumonia in a 10-year old girl. The patient had been healthy and had not been exposed to organic dusts or other toxic materials. The pathology of lung biopsy tissue showed that the alveoli were thickened by a mixture of chronic inflammatory cells and collagen type fibrosis. High resolution computed tomography(HRCT) found the patchy areas of ground-glass opacity with patchy consolidation and irregular reticular opacity, and diffuse distribution without zonal predominance. The forced vital capicity(FVC) was 31%, forced expiratory volume in one second ($FEV_1$) 29% and $FEV_1/FVC$ 90%, so a restrictive pulmonary insufficiency was found.

• Tuberculosis and Respiratory Diseases
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• v.52 no.4
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• pp.419-424
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• 2002

A 44 year old man was admitted complaining fo exertional dyspnea. The patient denied any occupational history of hard metal exposure. Chest radiography showed an increased interstitial marking at the peripheral portion of both lower lung fields. The spirometric values were within the normal ranges. However, the diffusion capacity of the lungs was lower. In the bronchial lavage fluid, the characteristic multinucleated giant cells were noticed, and the macrophage compartment was 96% and the neutrophils were 4%. High-resolution CT scan revealed ground glass opacities with emphysematous lung changes at the peripheral portion of the whole lung. An open lung biopsy confirmed the presence of numerous multinucleated giant cells (define GIP) with an associated interstitial fibrosis throughout the lung. The radiographic abnormailities and symptoms subsequently improved following treatment with oral corticosteroids.

• Journal of Yeungnam Medical Science
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• v.6 no.1
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• pp.21-29
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• 1989

A clinical study was made on 71cases of Mycoplasma pneumoniae pneumonia from March, 86 to February, 89. The results were as follows; 1. Among the 315 cases of pneumonia, the incidence of mycoplasmal infection was 22.5%. 2. The peak incidence of age was between 5 to 9years of age(53.5%). 3. The sex ratio of male to female was 1.3:1. 4. Monthly distribution showed relatively high frequency from October to January(59.2%). 5. Most common clinical symptoms were cough(98.6%)and then followed by fever(49.3%), coryza(19.7%). Rales were the most common finding(95.7%) and followed by pharyngeal injection (49.3%) and wheezing(18.3 %). 6. The leukocyte counts in peripheral blood were most common in the range of 5000-10000/$mm^3$(47.9%) and the ESR was increased in 57.7%, and positive CRP cases were 87.3%. 7. The most common radiologic finding of pulmonary infiltration was interstitial infiltration(45.1) and then followed by disseminated lobular(39.4%) and lobar pneumonia(15.5%). 8. There are a few cases associated disease or complication: otitis media (5.6%), hepatitis(4.2%) acute glomerulonephritis. bronchial asthma and sinusitis(2.8%), thrombocytopenia(1.4%).

• Tuberculosis and Respiratory Diseases
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• v.48 no.2
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• pp.260-267
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• 2000

Giant cell interstitial pneumonia. a synonym for hard metal pneumoconiosis, is a unique form of pulmonary fibrosis resulting from an exposure to hard metal dust. A case of biopsy-proved giant cell interstitial pneumonia in the absence of appropriate history of exposure to hard metal dust is reported. The patient presented with clinical features of chronic interstitial lung disease or idiopathic pulmonary fibrosis. He worked in a chemical laboratory at a fertilizer plant, where he had been exposed to various chemicals such as benzene and toluene. He denied having any other hobby in his house or job at work, which may have exposed him hard metal dust. High-resolution CT scan revealed multi-lobar distribution of ground glass opacity with peripheral and basal lung predominance. The retrieved fluid of bronchoalveolar lavage contained asbestos fiber and showed neutrotphil predominance. Surgical lung biopsy was performed for a definite diagnosis. Lung specimen showed alveolar infiltration of numerous multinucleated giant cells with mild interstitial fibrosis. Upon detailed examination of the lung tissue, one asbestos body was found. An analysis for mineral contents in lung tissue was performed. Compared with the control specimen, the amount of cobalt and several hard metal components in the lung tissue of this patient was ten times higher. We speculated that the inconsistency between occupational history and the findings of pathologic and mineralogical analyses could be explained by the difference in individual immunologic reactivity to hard metal dust despite the relatively small amount of unrecognized environmental exposure(ED: It's hard to understand what this phrase is trying to say).

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.65-74
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• 1999

Background : Open lung biopsy(OLB) has conventionally been regarded as the gold standard for the diagnosis in interstitial lung disease. With recent advances in diagnostic technique such as high resolution computed tomography(HRCT), and transbronchial lung biopsy(TBLB) which provide relatively accurate diagnosis of ILD, it is necessary to reevaluate the role of these methods in the diagnosis of ILD. Methods: We carried out a retrospective analysis of nineteen patients who underwent OLB at Dankook University Hospital for the diagnosis of acute and chronic ILD, between May 1995 and June 1998. By reviewing the medical records, the demographic findings, underlying conditions, HRCT and TBLB findings, OLB diagnosis, therapy after OLB, and complication of OLB were evaluated. Results: Thirteen patients(68.4%) had chronic ILD(symptom duration over 2 weeks prior to OLB), and six patients(31.6%) had acute ILD(symptom duration less than 2 weeks). Specific diagnosis were reached in 92%(12/13) of chronic ILD(5 bronchiolitis obliterans organizing pneumonia(BOOP), 2 constrictive bronchiolitis, 3 usual interstitial pneumonia, 1 hypersensitivity pneumonitis, 1 eosinophilic pneumonia), and in all patients of acute ILD(5 acute interstitial pneumonia, 1 pneumocystis carinii pneumonia). HRCT were performed in all patients and a correct first choice diagnosis rate of HRCT was 42%(5/12) in chronic ILD. In chronic ILD patients, 62%(8/13) received specific therapy(steroid therapy in 7 patients and moving in one patient), after OLB, but in acute ILD, all patients received specific therapy(steroid therapy in 5 patients and steroid and antibiotic therapy in one patient) after OLB. The in-hospital mortality after OLB was 5.3%(1/19). Conclusion: OLB is an excellent diagnostic technique with relatively low complications in patients with ILD. Therefore OLB should be considered in patients with ILD when the specific diagnosis is important for the treatment, especially in patients with acute ILD.

• Tuberculosis and Respiratory Diseases
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• v.45 no.2
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• pp.444-450
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• 1998

PCP remains the leading cause of deaths in patients with AIDS. As familiarity with PCP increases, atypical manifestations of the diseases are being recognized with greater frequency. There are following "atypical" manifestations of PCP ; 1) interstitial lung response that include diffuse alveolar damage, bronchiolitis obliterance, interstitial fibrosis, and lymphoplasmocytic infiltrate 2) striking localized process frequently exhibiting granulomatous features 3) extensive necrosis & cavitation 4) extrapulmonary dissemination of the disease. A wide variety of pathologic manifestations may occur in PCP in human immunodeficiency virus-infected patienst and that atypical features should be sought in lung biopsies from patients at risk for PCP. We had experienced a case of PCP, which presented with severe hypoxia, progressive dyspnea and fine crackles. It was diagnosed as PCP in AIDS with manifestation of BOOP by open lung biopsy and showed good response to Bactrim & corticosteroid therapy.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.383-390
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• 2008

Purpose : This study was aimed to analyze the clinical characteristics of patients with acute interstitial pneumonia who had presented similar clinical patterns from March to June, 2006 and to describe our experience of treatment and to identify risk factors associated with prognosis. Methods : The clinical characteristics, radiologic and histopathologic findings and response to steroids of 15 patients (non-survival group [n=7] and survival group [control, n=8]) with acute interstitial pneumonia were investigated through the review of medical records. Results : The mean age of the patients was 26 (range: 3-48) months. Cough, cyanosis and fever were frequent symptoms. The most frequent radiologic findings on admission were pneumomediastium and extensive ground glass opacity. Surgical lung biopsy was performed on 8/15 (53.3%) patients and diffuse alveolar damage was found. Mechanical ventilation was applied for 9/15 (60.0%) patients for 40 (range: 1-99) days. Five patients in survival group received steroid treatment and 7 patients in non-survivial group (P=0.20). One patient in survival group received steroid pulse treatment and 4 patients in non-survival group (P=0.12). Seven patients died all of respiratory failure. The survival rate was 53.4%. Conclusion : The patients with acute interstitial pneumonia which occurred on spring 2006 showed high mortality because of rapidly and extensively progressing pulmonary fibrosis and air leakage. Therefore, we should consider surgical lung biopsy and steroid application earlier. We should recognize this acute interstitial pneumonia occurring on spring in domestics and need to investigate the cause and treatment in large scale.

• Tuberculosis and Respiratory Diseases
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• v.51 no.1
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• pp.59-64
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• 2001

Nonspecific interstitial pneumonia (NSIP) was first described as a new category of idiopathic interstitial pneumonia in 1994. This is a disease with a more insidious onset and has a chronic course. The histological findings are unusual for other idiopathic interstitial pneumonia cases (usual interstitial pneumonia, diffuse interstitial pneumonia, and acute interstitial pneumonia). In contrast to NSIP, acute interstitial pneumonia (AIP) has an acute onset and a fulminant course with the rapid development of respiratory failure. A pathological examination demonstrated characteristic diffuse interstitial fibrosis, hyaline membranes, thrombi, and architectural derangement. Here we report a 48-year-old woman who was diagnosed pathologically NSIP, but with a rapid progressive course similar to AIP.