Ignacio Aranda

Idiopathic Organizing Pneumonia: A Relapsing Disease

Background: Although organizing pneumonia (OP) is a common pathological finding, studies including a substantial number of patients with idiopathic forms from a unique center and a long follow-up are rare. Objectives: To determine patients with cryptogenic forms of organizing pneumonia (COP), in order to characterize their clinical course, to identify predictive factors for relapse and to assess their effect on outcome. Methods: For a 19-year period, all histopathological reports from a community teaching hospital were reviewed, and OP was found in 210 lung specimens belonging to 197 patients. Results: Thirty-three (17%) patients presented cryptogenic forms and 32 of them (97%) responded to steroid therapy. At follow-up, 14 patients presented no relapses (no-relapse group, NR) and 18 (56%) presented relapses (relapsing group, RG) that resolved with ulterior treatment. Multifocal opacities on chest X-ray (RG 83% vs. NR 36%, p = 0.02) appeared to be a predictor for relapse. Patients with relapses showed a shorter time span to chest X-ray normalization (RG 8 ± 8 weeks vs. NR 13 ± 9 weeks, p = 0.09) that became significant in patients with 3 or more relapses (multiple-relapse group, MR, 4 ± 2 weeks vs. NR 13 ± 9 weeks, p < 0.04). Although the initial prednisone dose was similar in patients with relapsing forms, its maintenance was shorter than in patients without relapses, showing a trend to significance (RG 4 ± 3 weeks, NR 7 ± 6 weeks, p = 0.09). Lower levels of lactate dehydrogenase and γ-glutamyltransferase, although always within the normal range, were found in patients with relapsing forms. Conclusion: COP is a specific but infrequent form of OP with a good response to steroid therapy. Relapses are frequent and typical characteristics of COP which resolved with ulterior treatment. Multifocal opacities on chest X-ray and a shorter maintenance of the initial steroid dose may increase the risk of relapse.

Malignant Transient Pleural Transudate: A Sign of Early Lymphatic Tumoral Obstruction

In the absence of a responsible comorbid condition, the transudative character of a pleural effusion in patients with malignancy does not imply a favorable outcome. We report a case of colon carcinoma metastatic to lung and pleura presenting as a bilateral transudative pleural effusion. Tumoral diffuse lymphatic permeation was identified as the cause of lymphatic obstruction on pleural and transbronchial biopsies. The transudative character of the pleural effusion was transient denoting its obstructive origin.

Neumonía intersticial bronquiolocéntrica idiopática: una nueva neumonía intersticial idiopática

Las neumonias intersticiales idiopaticas son un grupo heterogeneo de enfermedades pulmonares, que comprenden un grupo de entidades clinicopatologicas que afectan de forma difusa al parenquima pulmonar. En el ano 2002 el consenso entre la American Thoracic Society (ATS) y la European Respiratory Society (ERS) unifico las caracteristicas de las diferentes entidades que conforman el grupo de las neumonias intersticiales idiopaticas. A pesar de este amplio consenso, continua habiendo entidades de las que no disponemos de una definicion clara y otras no incluidas que se describieron posteriormente, como la neumonia intersticial bronquiolocentrica idiopatica. Se presentan el caso y la evolucion de una paciente diagnosticada mediante biopsia pulmonar de neumonia intersticial bronquiolocentrica idiopatica.

Respiratory Failure Secondary to Organizing Pneumonia in a Patient with Membranoproliferative Glomerulonephritis and Lung Haemorrhage

We report the case of a woman with membranoproliferative glomerulonephritis type I who presented with acute respiratory failure secondary to alveolar haemorrhage. The persistence of the respiratory failure, once the alveolar haemorrhage had ceased, was apparently due to diffuse alveolar damage in organization. The recognition of this proliferative reaction through the performance of transbronchial biopsy allowed the initiation of a correct treatment with which a favourable response was obtained.

Idiopathic Bronchiolocentric Interstitial Pneumonia: A New Idiopathic Interstitial Pneumonia

Idiopathic interstitial pneumonias represent a diverse group of lung diseases with diffuse effects on the lung parenchyma. In 2002, the American Thoracic Society/European Respiratory Society consensus classification unified the descriptions of the different entities encompassed by idiopathic interstitial pneumonias. Despite this broad consensus there are still some entities without a clear definition and others, such as idiopathic bronchiolocentric interstitial pneumonia, that were only later described. We present the case and outcome of a woman diagnosed with idiopathic bronchiolocentric interstitial pneumonia by lung biopsy.

Lymphangitic Carcinomatosis as a Cause of Malignant Transient Pleural Transudate

Although it is generally accepted that a malignant transient pleural transudate may appear during the early stages of lymphatic obstruction, cases demonstrating such probability are rare in literature. A 67-year-old woman was admitted to hospital because a lymphangitic carcinomatosis and a transudative infrapulmonary pleural effusion with a cytology positive for adenocarcinoma. One month later the effusion keeps being positive for adenocarcinoma but exudative in character. Lymphatic obstruction appears as the cause of the initial transudative characteristics of the pleural effusion.