title: [Acute exacerbation of subacute interstitial pneumonia after thoracoscopic lung biopsy].
abstract: A 55-year-old woman was admitted to our hospital with progressive dyspnea that had begun one month before. Chest rentogenogram revealed groundglass appearance and reticular shadows bilaterally. Pulmonary function tests showed both decreased vital capacity and diffusing capacity. Bronchoalveolar lavage fluid had a high lymphocyte fraction with a low CD4+/CD8+ ratio. Thoracoscopic lung biopsy revealed thick, fibro-edematous interstitium and diffuse infiltration of lymphocytes. We also observed an intra-alveolar exudate with infiltration of histiocytes and lymphocytes. The clinical features and pathological findings were consistent with subacute interstitial pneumonia, which was the entity proposed by Kawabata and colleagues. The patient developed acute respiratory failure four days after lung biopsy and died despite steroid pulse therapy. Although subacute interstitial pneumonia has been reported to respond to steroid therapy, and to have a good prognosis, we believe that subacute interstitial pneumonia could fatally worsen when associated with lung biopsy, infection, or some other stimulus.
authors.affiliation: Department of Medicine, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Tasaka
authors.forename: M
authors.initials: M
authors.lastname: Kanazawa
authors.forename: Y
authors.initials: Y
authors.lastname: Komune
authors.forename: K
authors.initials: K
authors.lastname: Soejima
authors.forename: M
authors.initials: M
authors.lastname: Hirakata
authors.forename: K
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: M
authors.initials: M
authors.lastname: Naruke
authors.forename: M
authors.initials: M
authors.lastname: Mukai
authors.forename: Y
authors.initials: Y
authors.lastname: Kawabata
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
mesh_terms: D000208:Acute Disease; D001706:Biopsy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000473:pathology*; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology; D013906:Thoracoscopy / Q000009:adverse effects*