title: Toxic inhalational injury-associated interstitial lung disease in children.
abstract: Interstitial lung disease in children (chILD) is a group of disorders characterized by lung inflammation and interstitial fibrosis. In the past recent years, we noted an outbreak of child in Korea, which is possibly associated with inhalation toxicity. Here, we report a series of cases involving toxic inhalational injury-associated chILD with bronchiolitis obliterans pattern in Korean children. This study included 16 pediatric patients confirmed by lung biopsy and chest computed tomography, between February 2006 and May 2011 at Asan Medical Center Children's Hospital. The most common presenting symptoms were cough and dyspnea. The median age at presentation was 26 months (range: 12-47 months), with high mortality (44%). Histopathological analysis showed bronchiolar destruction and centrilobular distribution of alveolar destruction by inflammatory and fibroproliferative process with subpleural sparing. Chest computed tomography showed ground-glass opacities and consolidation in the early phase and diffuse centrilobular nodular opacity in the late phase. Air leak with severe respiratory difficulty was associated with poor prognosis. Although respiratory chemicals such as humidifier disinfectants were strongly considered as a cause of this disease, further studies are needed to understand the etiology and pathophysiology of the disease to improve the prognosis and allow early diagnosis and treatment.
authors.affiliation: Department of Pediatrics, Asan Medical Center Children's Hospital, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Eun
authors.initials: E
authors.lastname: Lee
authors.forename: Ju-Hee
authors.initials: JH
authors.lastname: Seo
authors.forename: Hyung Young
authors.initials: HY
authors.lastname: Kim
authors.forename: Jinho
authors.initials: J
authors.lastname: Yu
authors.forename: Won-Kyoung
authors.initials: WK
authors.lastname: Jhang
authors.forename: Seong-Jong
authors.initials: SJ
authors.lastname: Park
authors.forename: Ji-Won
authors.initials: JW
authors.lastname: Kwon
authors.forename: Byoung-Ju
authors.initials: BJ
authors.lastname: Kim
authors.forename: Kyung-Hyun
authors.initials: KH
authors.lastname: Do
authors.forename: Young Ah
authors.initials: YA
authors.lastname: Cho
authors.forename: Sun-A
authors.initials: SA
authors.lastname: Kim
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Jang
authors.forename: Soo-Jong
authors.initials: SJ
authors.lastname: Hong
mesh_terms: D018806:APACHE; D001980:Bronchi / Q000473:pathology; D002675:Child, Preschool; D003371:Cough / Q000209:etiology; D003520:Cyclophosphamide / Q000627:therapeutic use; D004202:Disinfectants / Q000633:toxicity*; D004417:Dyspnea / Q000209:etiology; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007136:Immunoglobulins / Q000627:therapeutic use; D007223:Infant; D001239:Inhalation; D017563:Lung Diseases, Interstitial / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D004202:Disinfectants; D004791:Enzyme Inhibitors; D007136:Immunoglobulins; D013256:Steroids; D006886:Hydroxychloroquine; D003520:Cyclophosphamide
keywords: Bronchioles; Inhalation; Lung Disease, Interstitial; Pulmonary Fibrosis; Toxin, Biological