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Pneumonitis

Presentation

[…] secondary to inhaled allergens Alternate/Historical Names Extrinsic allergic alveolitis (equvalent term) Many allergen specific names, a few of which are: Bird fancier's lung Farmer's lung Hot tub lung Humidifier lung Diagnostic Criteria Clinical May present [surgpathcriteria.stanford.edu]

Upon physical examination, the patient presented no fever, tachycardia (140 bpm), tachypnea (36 breaths per minute) and baseline oxygen saturation (breathing room air) of 91%. [archbronconeumol.org]

[…] obliterans Infectious pneumonia – especially M. tuberculosis Usual interstitial pneumonia Desquamative interstitial pneumonia Nonspecific interstitial pneumonia Drug-induced pneumonitis Chronic presentation Nonspecific interstitial pneumonia Unusual [arupconsult.com]

The first is always to consider a reaction to e-cigarettes in someone presenting with an atypical respiratory illness. [adc.bmj.com]

However, the potential for massive inhalation with the use of vaping devices could account for the more acute presentations of the current cases. [reliasmedia.com]

Entire Body System

  • Fatigue

    The subacute form is characterized by the insidious onset of productive cough, dyspnea, and fatigue over weeks to months. Chronic hypersensitivity pneumonitis is characterized by long-term progressive dyspnea, weight loss, cough, and fatigue. [amboss.com]

    To save this word, you'll need to log in. pneu·mo·ni·tis | \ ˌnü-mə-ˈnī-təs, ˌnyü- \ : acute or chronic inflammation of the lungs that is characterized especially by cough, shortness of breath, fatigue, and fever, and may result in the development of [merriam-webster.com]

    Initially, the symptoms are more like influenza, which include headache, dry cough, fever with low temperature, muscle pain, and fatigue. [news-medical.net]

    Subacute and chronic patients may present with acute exacerbation Subacute Gradual onset of dyspnea, cough over days or weeks Follows continued intermittent exposure Good response to steroids and avoidance/removal of antigen Chronic Chronic dyspnea, fatigue [surgpathcriteria.stanford.edu]

  • Pain

    Clinical symptoms can include: SOB (40-50%), cough (35%), fever, chest pain It can rapidly progress, leading to respiratory failure. [stgeorges.nhs.uk]

    Pneumonitis can cause: shortness of breath a low level of oxygen in the body fever cough chest pain with breathing Signs of pneumonitis caused by chemotherapy often start within days of getting it. [oncolink.org]

    Your chest pain or breathing problems do not go away or get worse. Your cough does not get better with treatment. You vomit or have diarrhea. You have questions or concerns about your condition or care. [drugs.com]

    Symptoms Symptoms of radiation pneumonitis include: fever cough chest congestion shortness of breath chest pain If symptoms get worse or don’t go away, report them to your doctor or healthcare team without waiting for your next scheduled appointment. [cancer.ca]

    Symptoms The symptoms include cough, shortness of breath and sometimes fever and joint pains. They can come on suddenly after you’ve been exposed. This is called acute HP. [blf.org.uk]

  • Lymphadenopathy

    Lymphadenopathy in left hilus, right hilus and paratracheal (1-2-3 sign). Often with calcifications. Uncommon findings: Conglomerate masses in a perihilar location. [radiologyassistant.nl]

    No mediastinal or axial pathologic lymphadenopathies were observed (see Fig. 1 ). [archbronconeumol.org]

    […] bronchiolar inflammation and obstruction: this may give a mosaic attenuation pattern 4 head cheese sign : the combination of patchy ground-glass opacities, normal regions, and air trapping Other associated features include: small volume mediastinal lymphadenopathy [radiopaedia.org]

    Hilar and mediastinal lymphadenopathy with hypersensitivity pneumonitis induced by penicillin. Chest 1992;102:1907–1909. de Hoyos A, Holness DL, Tarlo SM. [synapse.koreamed.org]

Respiratoric

  • Cough

    Alcohol dulls your urge to cough and sneeze. Alcohol also causes your body to lose fluid. This can make the mucus in your lungs thicker and harder to cough up. Drink more liquids. [drugs.com]

    The subacute form is characterized by the insidious onset of productive cough, dyspnea, and fatigue over weeks to months. Chronic hypersensitivity pneumonitis is characterized by long-term progressive dyspnea, weight loss, cough, and fatigue. [amboss.com]

    Symptoms The symptoms include cough, shortness of breath and sometimes fever and joint pains. They can come on suddenly after you’ve been exposed. This is called acute HP. [blf.org.uk]

  • Dyspnea

    The subacute form is characterized by the insidious onset of productive cough, dyspnea, and fatigue over weeks to months. Chronic hypersensitivity pneumonitis is characterized by long-term progressive dyspnea, weight loss, cough, and fatigue. [amboss.com]

    […] symptoms Fever, chills, malaise, nausea Cough may progress to respiratory insufficiency If purely acute, usually resolves in 1-2 days with supportive treatment Subacute and chronic patients may present with acute exacerbation Subacute Gradual onset of dyspnea [surgpathcriteria.stanford.edu]

    After three courses of therapy given at four-week intervals, at which time the patient had received a total of 6,300 mg of cyclophosphamide, fever, cough, and dyspnea developed, with roentgenographic evidence of diffuse interstitial pneumonitis and decreased [jamanetwork.com]

    The acute form of hypersensitivity pneumonitis, characterized by fever, chills, myalgias, cough, and dyspnea, may be confused with acute pneumonitis. [ncbi.nlm.nih.gov]

    At the 1-month follow-up visit, the patient was readmitted for worsening dyspnea. [cancernetwork.com]

  • Dry Cough

    This can lead to shortness of breath, a dry cough, and other symptoms. Over time, untreated pneumonitis can lead to lung damage and a condition called pulmonary fibrosis, which can be life-threatening. [kidshealth.org]

    Symptoms The most common symptom of pneumonitis is shortness of breath, which may be accompanied by a dry cough. [mayoclinic.org]

    Results: She was hospitalized 9 mo posttransplant with fever, dyspnea, and dry cough. Chest X-ray and CT scan showed bibasilar patchy interstitial infiltrates. [journals.lww.com]

    Symptoms The hallmark symptoms of pneumonitis include shortness of breath, dry cough, low-grade fever, chest tightness and/or pain and general malaise. [curetoday.com]

  • Aspiration

    Diagnostic bronchoscopy demonstrated no endobronchial lesions, and samples were taken from the bronchoalveolar lavage and aspirate as well as a transbronchial biopsy. [archbronconeumol.org]

    Initial assessment – patient seen in AOCU Investigations: Bloods: FBC, U&E, LFTs, CRP, TFTs Sputum sample: MC&S, screening for viral, opportunistic or specific bacterial infections Nasopharyngeal aspirate: for viral PCR Urine: Legionella/pneumococcal [stgeorges.nhs.uk]

    Inhalation of foreign matter, usually of stomach contents when vomiting (aspiration pneumonitis). Pertussis. Exposure to an inhaled allergen (hypersensitivity pneumonitis) - eg, humidifier lung, farmer's lung, bird fancier's lung. [patient.info]

    Other conditions are also in the differential diagnosis: heart failure, aspiration pneumonia, and thromboembolism. “Among the patients referred to us who we work up for pneumonitis, 30% to 40% will have one of these other entities,” he said. [ascopost.com]

    Aspiration Pneumonitis and Pneumonia. Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec05/ch052/ch052f.html. Accessed May 2010. Bartlett, J. (Revised 2008 May). [labtestsonline.it]

  • Respiratory Distress

    Complications Severe acute or subacute flares may cause severe respiratory distress and can be life-threatening. Recurrent pneumonia. Pneumothorax. Pulmonary fibrosis. Cor pulmonale. Chronic obstructive pulmonary disease. [patient.info]

    The absence of marked neutrophilia in lung tissue ruled out a diagnosis of acute respiratory distress syndrome ( Fig. 2B ). [ncbi.nlm.nih.gov]

    The histologic pattern aswell as the HRCT findings in AIP are indistinguishable from acute respiratory distress syndrome (ARDS). [radiologyassistant.nl]

    Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533. Khunger M, et al. [jci.org]

Cardiovascular

  • Hypertension

    Characteristics of patients with sirolimus-associated pneumonitis Patient Age Gender Nephropathy Time since RTx (months) Immunosuppression Onset of symptoms (months) 1 61 M Hypertensive nephropathy 15 S,P (2 mg/day) 5 2 62 M Chronic glomerulonephritis [academic.oup.com]

    Fibrosis results in obliteration of pulmonary vessels, which can lead to pulmonary hypertension. Sarcoidosis with fibrosis in the upper lobes. Typical HRCT findings. On the left another case of stage IV sarcoidosis. [radiologyassistant.nl]

Urogenital

  • Renal Insufficiency

    The tolerance against sirolimus may be altered in the presence of severe renal insufficiency as it is well known for other drug toxicities e.g. neurotoxicity of calcineurin inhibitors in the presence of liver failure [ 15 ]. [academic.oup.com]

    insufficiency, arthralgia and myocarditis and pericarditis) Pulmonary infarcts The images on the left show the similarities between chronic eosinophilic pneumonia and organizing pneumonia. [radiologyassistant.nl]

Workup

Grade it per the Common Terminology Criteria for Adverse Events and direct further workup and management by the toxicity grade. For grade 2 or higher, perform a nasal swab and sputum and urine culture and sensitivity as part of an infectious workup. [voice.ons.org]

Workup Recommendations Workup of patients with suspected pneumonitis includes sputum cultures and nasopharyngeal swabs. It is especially important to look for evidence of viral infection in the winter months. [ascopost.com]

Blood workup revealed normal ionogram, C-reactive protein 80 g/dl, leukocytes 11 430 mm 3 (90% neutrophils and 1.4% eosinophils), hemoglobin 12.4 g/dl, hematocrits 36.4%, platelets 309 000 mm 3. [archbronconeumol.org]

X-Ray

  • Pulmonary Infiltrate

    We conclude that granulomatous IP is an uncommon side effect of SRL that should be considered in the differential diagnosis of febrile transplant patients with pulmonary infiltrates. [journals.lww.com]

    Hypersensitivity Pneumonitis and Pulmonary Infiltrates with Eosinophilia. Harrison’s Principles of Internal Medicine. 18th ed. McGraw-Hill Global Education Holdings; Dalphin JC, Debieuvre D, Pernet D, et al. [emedicine.medscape.com]

    ‘Atypical’ features described: GGO confined to the area around the tumor (peritumoral infiltration; PTI); GGO or consolidation around radiation fibrosis consistent with the radiation field (exacerbation of radiation fibrosis); diffuse pulmonary infiltration [futuremedicine.com]

    Clinically, patients with CIP present with acute to subacute onset of dyspnea, hypoxemia, and pulmonary infiltrates similar to that seen in patients with lung injury from acute respiratory distress syndrome ( 6 ). [jci.org]

Treatment

The most common risk factor is related to treatment protocols. [curetoday.com]

His symptoms improved with corticosteroid treatment, worsened when corticosteroids were tapered, and then finally resolved after treatment with the TNF-alpha-inhibitor infliximab. [jitc.biomedcentral.com]

In this study, opacity confined to the ipsilateral lung was observed after nivolumab treatment. [futuremedicine.com]

It is not intended as medical advice for individual conditions or treatments. [drugs.com]

[…] may begin as soon as possible: discontinuation or a change of immunosuppressive treatment and addition of corticosteroid treatment if necessary. [revistanefrologia.com]

Prognosis

Steroid therapy is helpful for symptomatic relief, but probably does not affect the long-term prognosis. [mayoclinic.pure.elsevier.com]

Prognosis Prognosis is good with early diagnosis and management. Late-diagnosed chronic pneumonitis may lead to progressive, irreversible lung disease. [patient.info]

However, when smokers do develop hypersensitivity pneumonitis, it is more commonly fibrosing disease with a worse prognosis 10. [radiopaedia.org]

Centrilobular accentuation of peribronchiolar fibrosis is very suggestive of hypersensitivity pneumonitis Surrounds and may occlude bronchiole Fibrosis may bridge from centrilobular to peripheral zones Fibrosis is generally not reversible and imparts a poor prognosis [surgpathcriteria.stanford.edu]

The prognosis for the acute form is good. Once severe damage to lung structures has occurred, however, few treatment options remain. Chronic hypersensitivity pneumonitis may lead to pulmonary fibrosis, which may ultimately require transplantation. [amboss.com]

Etiology

They received empiric antibiotics recommended for treatment of community-acquired pneumonia, but tests for microbiological etiologies proved negative. [reliasmedia.com]

One is confronted with the same difficulty in placing the pneumonias, though some progress is being made toward adoption of an etiological classification. [annals.org]

[…] type of pulmonary inflammation on the basis of roentgen findings alone, it is both sensible and convenient for the radiologist to report findings which suggest chronic fibroid pneumonia as “interstitial pneumonitis,” making no attempt to identify the etiologic [pubs.rsna.org]

He has also reviewed more or less extensively the facts as to the etiology, pathology, anatomy, symptomatology, etc., of the disease, and it may be taken as—for its size—a fairly exhaustive and critical discussion of the subject. [jamanetwork.com]

Etiology Combined type III and type IV hypersensitivity reaction with genetic predisposition Inhalation of organic particles ( < 5 microns ), primarily through occupational exposure (notifiable occupational disease) Antigen Source Disease Animal proteins [amboss.com]

Epidemiology

Epidemiology of hypersensitivity pneumonitis among an insured population in the United States: a claims-based cohort analysis. [revistas.asoneumocito.org]

Epidemiology It is common, if all causes of pneumonitis are considered. [patient.info]

Chronic presentation Nonspecific interstitial pneumonia Unusual interstitial pneumonia Bronchiolitis obliterans Chronic obstructive pulmonary disease (COPD) Idiopathic pulmonary fibrosis Sarcoidosis Asthma Silicosis Drug-induced pneumonitis Background Epidemiology [arupconsult.com]

Epidemiological study of farmer's lung in five districts of the French Doubs province. Thorax. 1988 Jun. 43(6):429-35. [Medline]. [Full Text]. Terho EO. Work-related respiratory disorders among Finnish farmers. Am J Ind Med. 1990. 18(3):269-72. [emedicine.medscape.com]

Pathophysiology

[…] s lung, paprika slicer’s lung, wine maker’s lung, tobacco grower’s lung Animal proteins Pituitary snuff taker’s lung, pigeon breeder's lung, bird fancier’s disease, furrier’s lung, poultry worker's lung Chemicals Bathtub finisher's lung, Coptic lung Pathophysiology [arupconsult.com]

Details of the pathophysiology of this disease are still unknown, but for drugs with a high volume of distribution, one possibility would be specific accumulation of the mTOR inhibitor or its metabolites in the lung parenchyma. [revistanefrologia.com]

Despite the frequency with which both radiation- and ICB- related pneumonitis occur, the pathophysiology remains unclear, and there is little data to suggest which clinical risk factors might be the most relevant. [jitc.biomedcentral.com]

The precise pathophysiology of the differences between PD1/PDL-1 inhibitors and CTL-4 inhibitors is yet to be uncovered. [frontiersin.org]

Prevention

Oxygen therapy to prevent a low level of oxygen in the body. Bronchodilators may be given to help open up the lungs for better oxygenation. Steroids may be given to lessen inflammation and help the lungs heal. If you smoke, stop. [oncolink.org]

(November 6, 2017) Centers for Disease Control and Prevention. CDC Features: Pneumonia can be prevented—vaccines can help. Available online at https://www.cdc.gov/Features/Pneumonia/. Accessed on September 8, 2018. [labtestsonline.it]

The chronic form of this condition can be prevented by avoiding the material that causes the lung inflammation. [uihc.org]

The chronic form can be prevented by avoiding the material that causes the lung inflammation. [medlineplus.gov]

The inflammation can make it hard to breathe and prevent you from getting enough oxygen. Anything that irritates your lung tissues can lead to pneumonitis. The longer you are exposed, the more damage your lungs will develop. [drugs.com]

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