Inerstitial Lung Diseases

Question 0

What characterises sarcoidosis ?

Answer 0

Non caseating granulomas (90% in the lung), bilateral hilar lymphadenopathy 
Onset usually in 3rd or 4th decade
Cough, malaise, arthralgia
Erythema nodosum
Ocular lesions eg anterior uveitis

Erythema nodosum with an acute swinging fever, malaise, arthralgia in a young adult female

Question 1

What characterises interstitial lung disease and give 2 examples

Answer 1

• inflammation and fibrosis of the interalveolar septum, representing a non specific reaction of the lung to injuries of various causes
• sarcoidosis, interstitial pulmonary fibrosis

Question 2

How is sarcoidosis diagnosed?

Answer 2

Biopsy
Supportive features
- Elevated ACE
- restrictive lung function test
- elevated serum calcium

Question 3

What is the treatment for sarcoidosis?

Answer 3

May resolve spontaneously. Treat with corticosteroids if

• no spontaneous resolution after 3-6 months
• symptomatic pulmonary lesions
• Eye, CNS, other systems involvement
• hypercalcaemia, hypercalcuria
• erythema nodosum with arthralgia
• persistent cough

Question 4

What characterises idiopathic fibrosing interstitial pneumonia?

Answer 4

5th to 7th decade
Slowly progressive dyspnoea over months to years
Cxr: diffuse nodular or reticule nodular shadowing at lung bases
Death 2-5 years after diagnosis

Question 5

What drugs can cause interstitial lung disease?

Answer 5

1. Eosinophic: Various antibiotics, NSAIDs, cytotoxic agents, major tranquillisers and antidepressants, anti epileptics
2. Alveolitis +/- pulmonary fibrosis: cytotoxic drugs, nitrofurantoin, amiodarone
3. non cardiogenic APO: opioids, aspirin, HCT, b2 agonists, cytotoxics