CHEST Guidelines-A-75-Year-Old-Man-With-Organizing-Pneumonia-Presen

A-75-Year-Old-Man-With-Organizing-Pneumonia-Presen

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The document is a case study of a 75-year-old man experiencing worsening dyspnea, decreased activity tolerance, myalgias, and increased oxygen requirements. Initially, he was diagnosed with organizing pneumonia (OP) through a VATS lung biopsy at an external hospital and treated with prolonged steroids. Despite this treatment, his condition worsened, prompting a referral to another institution.<br /><br />At the new facility, his physical examination showed bilateral inspiratory crackles and required increased oxygen supplementation. Diagnostic tests revealed reduced lung function and ground-glass opacities in the chest, indicative of organizing lung injury and consistent with antisynthetase syndrome (AS). Laboratory tests confirmed the presence of antibodies associated with AS, specifically Jo-1 and SSA, but not others typically observed in connective tissue diseases (CTDs).<br /><br />AS is a subset of idiopathic inflammatory myopathies characterized by autoantibodies like ARS and clinical features such as interstitial lung disease (ILD), arthritis, and fever. Radiographic findings in AS-related ILD commonly include ground-glass opacities and traction bronchiectasis. Treatment typically starts with corticosteroids, but due to their side effects, steroid-sparing agents like mycophenolate mofetil (MMF) or IV immunoglobulin (IVIG) are also utilized.<br /><br />This patient's modest response to steroids necessitated the use of MMF and IVIG, leading to improvement over five months, including better exercise capacity and reduced oxygen needs. The case emphasizes the need for comprehensive autoantibody testing in newly diagnosed ILD patients to differentiate between CTD-ILD and idiopathic interstitial pneumonia for better treatment response and prognosis.

Keywords

dyspnea

organizing pneumonia

antisynthetase syndrome

interstitial lung disease

autoantibodies

mycophenolate mofetil

IV immunoglobulin

ground-glass opacities

corticosteroids

connective tissue diseases