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Abstract: The patient presented with cough and yellow sputum with high sputum volume after getting cold half a month ago, accompanied by fever, and did not improve after 1 week of intravenous clindamycin hydrochloride, and developed shortness of breath at rest, so he came to our hospital. Based on pulmonary imaging and medical history, the preliminary diagnosis was acute interstitial pneumonia. The patient was given oxygen and medication. After 10 days of hospitalization, the patient’s dyspnea, cough and sputum decreased, his body temperature returned to normal, and his mobility and quality of life improved.
Basic information】Male, 64 years old
Disease Type】Acute interstitial pneumonia
Hospital】The First Hospital of Harbin Medical University
Date of consultation】May 2022
Treatment plan】Oxygen absorption + medication (moxifloxacin hydrochloride tablets, tranylcypromine hydrochloride spray + prednisolone acetate tablets)
Treatment Period】Hospitalization for 10 days, review after 3 months
Treatment effect】Rescued dyspnea, cough and sputum, normalized body temperature, improved mobility and quality of life
I. Initial consultation
The patient developed cough and yellow sputum with high sputum volume after getting cold half a month ago, accompanied by fever, body temperature up to 38℃, no chill, chills, and peripheral weakness, and was treated with intravenous injection of clindamycin hydrochloride outside the hospital for 1 week. After out-of-hospital treatment, he felt no relief from shortness of breath and cough, and a repeat lung CT indicated that the ground glass lesions in both lungs were larger than before. The patient had a history of diabetes mellitus and smoking, and had a chronic cough and sputum on weekdays.
II. Treatment history
The patient had an acute onset of the disease and was scheduled for blood gas analysis, antinuclear antibody, ANCA examination, complete blood count, calcitoninogen, liver and kidney function tests, etc. The results indicated that the patient had pulmonary infection, increased leukocyte and lymphocyte ratios, and a diagnosis of acute interstitial pneumonia with severe type I respiratory failure and hypokalemia. Based on the above examination results, the patient was given oxygen to improve respiratory failure, instructed the family to tap his back to expel sputum, and given moxifloxacin hydrochloride tablets for anti-infection, ambroxol hydrochloride spray to resolve sputum, and prednisolone acetate tablets for anti-inflammation, and instructed to pay attention to rest and strengthen nutrition.
III. Treatment effect
After the patient was treated with oxygen and medication, the blood gas analysis showed that the respiratory failure was significantly improved, the symptoms of dyspnea were reduced, the body temperature was reduced to normal, the symptoms of cough and sputum were significantly reduced, the sputum volume was significantly reduced, and the inflammation indexes were basically restored to normal after the review. At the same time, the patient’s appetite increased, and his mobility and quality of life improved. He was discharged from the hospital after 10 days of hospitalization, and was instructed to review his condition after 3 months.
IV. Notes
We are glad that the patient’s condition improved after treatment, but the patient should pay attention to rest in daily life, avoid exertion, enhance physical fitness, improve airway defense ability, avoid getting cold and flu, and avoid inhaling cold air. Strengthen nutrition, eat a light diet, eat foods rich in vitamins and proteins, should not be too full, and at the same time, quit smoking and alcohol. Patients should have regular monitoring of lung function and blood gas analysis, and regular outpatient follow-up. There is no accepted treatment plan for acute interstitial pneumonia. If patients develop cough and cough yellow sputum, they should be treated with active anti-infection and sputum chemotherapy based on sputum culture and drug sensitivity, or empirical medication, and glucocorticoids are more effective for patients with mainly ground glass lesions on imaging.
V. Personal insight
The etiology of acute interstitial pneumonia is unknown, and the main histopathological feature is diffuse alveolar injury, with lung lesions in the exudative phase within 1 week of onset and infiltration of inflammatory cells in the alveoli, which causes cough and progressive dyspnea in patients. Acute interstitial pneumonia is most often seen in patients with respiratory tract infections, and typical symptoms include fever, cough, sputum and dyspnea. As in this patient, early application of glucocorticoid therapy at the onset of these symptoms, and active control of infection, sputum, and timely symptomatic support treatment have kept the airway drainage open and prevented further deterioration of lung function.