DQ Question
Question 10: Explain pneumonitis: how it occurs, presents, including imaging findings, and is treated.
Pneumonitis is an inflammation of the lung tissue. The most common type of pneumonitis is Hypersensitivity Pneumonitis (HP). HP occurs following exposure of lung tissue to an inhaled inciting antigen that causes a host immunologic reaction determining interstitial inflammation and architectural distortion (Leone & Richeldi, 2020). Repeated exposure to antigens in genetically susceptible persons leads to acute neutrophilic and mononuclear alveolitis. This is followed by interstitial lymphocytic infiltration and granulomatous reaction. Continued exposure leads to fibrosis with bronchiolar obliteration.
Signs and symptoms and signs depend on whether the onset is Acute, Chronic, or Subacute. Acute HP presents with cough, fever, chills, bilateral vice-like chest tightness, and dyspnea 4-8 hours after exposure. Anorexia, nausea, and vomiting may be present. Physical exam findings include tachypnea and diffuse inspiratory crackles (Leone & Richeldi, 2020. Chronic HP manifests as onset over months to years of productive cough, exertional dyspnea, fatigue, and weight loss. Subacute HP falls between the acute and chronic forms and presets with dyspnea, cough, fatigue, and anorexia that develops over days to weeks or as acute symptoms superimposed on chronic ones.
The typical finding on High-Resolution CT includes the presence of profuse, poorly defined centrilobular micronodules. In chronic HP, there are findings of lung fibrosis like lobar volume loss, linear or reticular opacities, and honeycombing. Treatment of acute and subacute HP is with corticosteroids, typically prednisone 60 mg orally OD for 1-2 weeks. The dose is tapered over the next 2-4 weeks to 20 mg OD, followed by weekly decrements of 2.5 mg until the medication is stopped (Alberti et al., 2021). Treatment of chronic HP is usually with longer courses of prednisone 30-40 mg orally OD. Tapering is dependent on the clinical response.
References
Alberti, M. L., Rincon-Alvarez, E., Buendia-Roldan, I., & Selman, M. (2021). Hypersensitivity pneumonitis: diagnostic and therapeutic challenges. Frontiers in Medicine, 8, 718299. https://doi.org/10.3389/fmed.2021.718299
Leone, P. M., & Richeldi, L. (2020). Current Diagnosis and Management of Hypersensitivity Pneumonitis. Tuberculosis and respiratory diseases, 83(2), 122–131. https://doi.org/10.4046/trd.2020.0012
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