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Abstract: A 58-year-old female patient with a cough and white sputum with chest tightness and wheezing that began 1 year ago, mostly evident after activity, and worsened over 6 months compared to the previous period, with interstitial lung fibrosis suggested by chest CT. The patient in this case was mainly treated with symptomatic supportive therapy, including home oxygen therapy, pharmacological anti-fibrosis, anti-infection, and ventilator-assisted ventilation, etc. The patient’s symptoms were relieved.
Basic information】Female, 58 years old
Disease Type】Interstitial lung fibrosis
Hospital】Wuhan University People’s Hospital
Date of Consultation】June 2021
Treatment plan】Intravenous infusion (cefoperazone sodium sulbactam sodium for injection, moxifloxacin hydrochloride sodium chloride injection, methylprednisolone sodium succinate for injection) + oral medication (ambroxol hydrochloride tablets, pirfenidone capsules)
[Treatment period] 15 days of inpatient treatment, outpatient follow-up
Treatment effect】The patient’s symptoms such as chest tightness, cough and dyspnea after activity were relieved
I. Initial consultation
Patient’s self-report: 1 year ago, he started to cough and cough white sputum, accompanied by chest tightness and wheezing symptoms, mostly aggravated after activities and accompanied by a decrease in blood oxygen saturation, during which he intermittently performed home oxygen therapy, and his symptoms were generally controlled. In the past six months, the patient’s cough, sputum, and wheezing symptoms were significantly worse than before, and his activities were limited, and his blood oxygen dropped (fluctuated around 90%) with slight activities under oxygenation (3L/min). He had a history of interstitial pneumonia for more than 10 years and systemic lupus erythematosus for more than 10 years, and was currently treated with daily oral hormone methylprednisolone tablets.
On examination, the patient was still conscious, with shortness of breath, cyanosis, coarse breath sounds on auscultation, and Velcro rales in both lower lungs.
II. Treatment history
After admission, routine blood tests were completed, and the results indicated that the inflammatory index was significantly elevated. Blood gas analysis indicated: type I respiratory failure. Chest CT indicated: interstitial lung fibrosis. Sputum culture did not show significant bacterial growth, and pulmonary function + diffusion suggested restrictive ventilation dysfunction and decreased diffusion function.
Based on the patient’s past medical history, clinical symptoms, signs and relevant examination findings, the diagnosis was acute exacerbation of interstitial fibrosis, pulmonary infection and type I respiratory failure. The patient was admitted to the hospital in critical condition with shortness of breath, and there was a risk of exacerbation of respiratory failure leading to ARDS if the lung infection was not controlled. Oral anti-fibrotic treatment. At the same time, non-invasive ventilator-assisted ventilation was performed to improve the patient’s lung function and correct respiratory failure.
III. Treatment effect
After 15 days of treatment with the above active therapeutic measures, the patient’s blood gas analysis showed that the respiratory failure was corrected, and the blood routine showed that the inflammation index was slightly improved, so we were glad that the patient’s condition improved.
IV. Precautions
We are glad that the patient’s symptoms have been relieved in this case. In daily life, we should pay attention to rest, avoid strain, cold and flu, quit smoking, and avoid exposure to cold air, irritating gas and particles. We should strengthen the nutrition, eat meat, eggs, milk, fish and other high-protein diet to enhance physical fitness, continue to take oral methylprednisolone tablets + pirfenidone capsules outside the hospital, and pay attention to potassium and calcium supplementation during long-term hormone use.
V. Personal insight
Pulmonary fibrosis in this patient is considered to be caused by systemic lupus erythematosus leading to connective tissue disease-related interstitial lung disease. HRCT of the chest is one of the necessary tests for the diagnosis of pulmonary fibrosis, and pulmonary function mostly indicates restrictive ventilation dysfunction and decreased diffusion function. The average survival time due to different etiologies of pulmonary fibrosis varies, and the overall prognosis is poor. Patients should pay attention to rest, avoid exertion and cold, avoid acute infection leading to exacerbation, and end-stage symptomatic supportive therapy, including home oxygen therapy, anti-fibrosis, anti-infection, and ventilator-assisted ventilation.