(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient had an intermittent cough for more than 2 years, aggravated by wheezing after activity for 6 days. The patient was admitted to our emergency department one day ago for further treatment of his cough, coughing yellow mucus sputum with high volume, fever and shortness of breath after activity. After admission, he was diagnosed with idiopathic interstitial pulmonary fibrosis based on imaging and related examinations, and his symptoms were relieved after drug treatment.
Basic information】Male, 60 years old
Disease Type】Idiopathic interstitial pulmonary fibrosis
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】December 2021
Treatment plan】Medication (prednisone acetate tablets + amoxicillin capsules + pirfenidone tablets)
Treatment period】10 days of inpatient treatment, 3 months of outpatient follow-up
Treatment effect] The disease has been relieved
I. Initial consultation
The patient has had intermittent cough for more than 2 years, with aggravation and wheezing after activity for 6 days. The patient told us that he had a dry cough with no obvious cause 2 years ago, but no fever, chest pain, chest tightness, night sweats, wasting, joint pain, dry mouth and eyes, hair loss, skin rash, light allergy, etc. In March 2020, a CT scan of the chest at a local hospital showed lattice-like changes in the thickening of the lobular septa of both lungs, which was not treated, and there was no significant decrease in physical activity. In September 2021, he developed nasal congestion, runny nose, coughing and white sputum, and was treated with oral cold and flu granules, but his nasal congestion and runny nose improved, but he still coughing and coughing white sputum, and he developed chest tightness and wheezing after activity, and felt wheezing after walking 100 meters on flat ground or climbing 3 floors of a building, without fever, chest pain and hemoptysis. The lung CT was repeated: diffuse lattice shadow and ground glass shadow in both lungs, mainly in the outer zone and subpleural area, and idiopathic pulmonary fibrosis was considered. In the past 3 months, the patient’s wheezing was obvious after activity, and his activity tolerance was lower than before, and his cough and sputum were not significantly worse than before. 6 days ago, he developed a cough and yellow mucous sputum with high volume, accompanied by fever, and shortness of breath after activity, which worsened progressively, without chest pain and night sweats.
II. Treatment history
The patient had been ill for nearly 2 years without systematic examination and treatment. In order to clarify the cause of the disease, the patient was recommended to be hospitalized, and the following treatment measures were taken after admission.
1, bronchoscopy was done to retain pathology with the aim of ruling out exacerbation of the disease due to infection, and no infectious agents were reported after 3 days.
2, alveolar lavage fluid cell count classification: no cancer cells were seen, more neutrophils and lymphocytes were seen.
3, perfect ANA profile, ANCA related tests were negative. The patient had no connective tissue disease-related manifestations such as arthralgia, rash, dry mouth and eyes, mechanic’s hand, light allergy, etc. For the time being, connective tissue disease-related interstitial pneumonia was not considered. Based on the imaging features: subpleural lattice shadow and foveal shadow in both lungs, with visible traction bronchial dilatation, idiopathic pulmonary interstitial fibrosis was considered, and prednisone acetate tablets were added.
As the patient had cold factors and significant yellow sputum, oral amoxicillin capsules were given to control the infection. It was recommended to add pirfenidone tablets after discharge, and the hormone was gradually reduced, and then the hormone was stopped orally.
III. Treatment effect
The patient’s dyspnea, fever, and cough symptoms were quickly relieved by hormone therapy after diagnosis, and the lung CT was rechecked at 10 days of hospitalization, and the images were absorbed, and the patient was granted discharge. Since idiopathic pulmonary interstitial fibrosis is a chronic disease, the patient was advised to continue to take oral pirfenidone tablets after discharge and gradually reduce the dosage according to the recovery of the disease, and to pay attention to the side effects of the drug, and to review the outpatient clinic in 3 months. In addition, because the prognosis of this disease is relatively poor, it is important to monitor lung CT and lung function regularly.
IV. Precautions
We are glad that the patient’s symptoms have improved significantly after treatment, but note that the patient still needs to pay attention to the following matters after discharge from the hospital.
1, the patient must follow the doctor’s instructions after discharge to take the drugs on time and in accordance with the dosage, avoid stopping or reducing the drugs on their own, so as not to affect the recovery of the disease, and pay attention to follow the doctor’s instructions to regularly go to the hospital to review the lung CT and lung function, and adjust the dosage of drugs according to the specific situation.
2, also pay attention to maintain a healthy diet in daily life, with a light diet, avoiding spicy and irritating food.
3, adjust a healthy lifestyle is very important, first of all, must avoid drinking and smoking to avoid aggravation, and at the same time can carry out appropriate exercise to enhance their own physical fitness. If there are uncomfortable symptoms, be sure to seek medical examination in a timely manner.
V. Personal insight
Since the prognosis of patients with idiopathic interstitial lung fibrosis is relatively poor, it is usually due to the patients’ lack of knowledge about the disease, which is easily mistaken for infectious diseases. Moreover, many patients are resistant to the application of hormones, as well as many clinical diseases can appear as common type interstitial pneumonia similar to idiopathic pulmonary interstitial fibrosis. Therefore, in order to clarify the diagnosis of idiopathic pulmonary interstitial fibrosis, the following diseases need to be identified.
1. occupational and environmental factor exposure-associated interstitial pneumonia: inorganic or organic dusts may cause common type interstitial pneumonia, such as in miners.
2. connective tissue disease-associated interstitial pneumonia: most connective tissue diseases can lead to interstitial lung disease. Therefore, autoimmune antibodies and myositis-specific antibody profiles need to be refined upon admission for further clarification.
If the diagnosis of idiopathic pulmonary interstitial fibrosis is confirmed, do not be anxious, usually, as in this patient, timely medical treatment after treatment, the disease can be effectively alleviated.