title: Computed tomography image analysis before and after treatment of anti-neutrophil cytoplasmic antibody-associated pulmonary interstitial fibrosis in 8 patients.
abstract: OBJECTIVE
  The purpose of this study was to observe the treatment response of anti-neutrophil cytoplasmic antibody (ANCA)-associated pulmonary interstitial fibrosis in 8 patients before and after glucocorticoid or immunosuppressive therapy.
  
  
  METHODS
  The clinical features and computed tomography imaging findings of the 8 patients in our hospital from October 2011 to October 2013, were retrospectively analyzed.
  
  
  RESULTS
  Mean age of the 8 patients was 72.6 (range 60-80) years. Five patients exhibited cough, sputum, and chest tightness, including 2 patients with fever. One patient developed hemoptysis, 1 patient exhibited abnormal urinalysis and developed renal insufficiency, and 1 patient developed limb pain. Two patients exhibited high urine erythrocytes and 2 patients had renal dysfunction and urinary abnormalities. One of the latter patients, upon renal biopsy, had focal proliferative necrotizing glomerulonephritis (consistent with vasculitis damage) with stage II to III mild nephropathy. Seven cases were anti-myeloperoxidase-ANCA, and 1 case was anti-proteinase 3-ANCA. All 8 cases exhibited streaks and grid shadows in chest imaging; 2 cases exhibited limited ground-glass patches; 1 case displayed multiple large patches of exudative shadows, indicating diffuse alveolar hemorrhage; 2 cases exhibited obvious honeycomb manifestations; and 1 case exhibited significant traction bronchiectasis. The ground-glass opacities disappeared after corticosteroid or immunosuppressive therapy; however, for streaks and grid shadows, no significant changes in the images were observed after treatment from 2 weeks to 10 months.
  
  
  CONCLUSIONS
  ANCA-associated pulmonary interstitial fibrosis most often in elderly patients with many complications. In these patients ground-glass opacities in computed tomography images, corticosteroid or immunosuppressant therapy may be effective. Clinicians should consider the poor efficacy and side effects of these therapies in the fibrosis stage of the disease.
authors.affiliation: Department of Inpatient, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China.
authors.forename: Ai-Ping
authors.initials: AP
authors.lastname: Yu
authors.affiliation: Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China. Electronic address: jingxiachang18@163.com.
authors.forename: Jing-Xia
authors.initials: JX
authors.lastname: Chang
authors.affiliation: Department of Inpatient, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China.
authors.forename: Yan-Jin
authors.initials: YJ
authors.lastname: Liu
authors.affiliation: Department of Inpatient, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China.
authors.forename: Qing-Rong
authors.initials: QR
authors.lastname: Qu
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D053146:Myeloblastin / Q000276:immunology; D009195:Peroxidase / Q000276:immunology; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000276:immunology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009195:Peroxidase; D053146:Myeloblastin
keywords: ANCA; PIF; anti-neutrophil cytoplasmic antibody; computed tomography; pulmonary interstitial fibrosis