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Hans Dabó , Serviço de Pneumologia do Centro Hospitalar São João, EPE

3º CURSO DE DOENÇAS PULMONARES DIFUSAS CLINICAL CASE. Hans Dabó , Serviço de Pneumologia do Centro Hospitalar São João, EPE. IDENTIFICATION. 51 years old male Caucasian Judicial officer Living in Oporto. HISTORY OF PRESENTING ILLNESS. 3 years before. Progressive dyspnea on exertion

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Hans Dabó , Serviço de Pneumologia do Centro Hospitalar São João, EPE

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  1. 3º CURSO DE DOENÇAS PULMONARES DIFUSAS CLINICAL CASE Hans Dabó, Serviço de Pneumologia do Centro Hospitalar São João, EPE

  2. IDENTIFICATION • 51 years old male • Caucasian • Judicial officer • Living in Oporto

  3. HISTORY OF PRESENTING ILLNESS 3 years before • Progressive dyspnea on exertion • Intermitent wheezing and dry cough No complaints… • Fever, anorexia or weight loss • Pain, heat or swelling of the joints • Palpitations, orthopnea, PND or peripheral edema

  4. HISTORY OF PRESENTING ILLNESS 3 months before CHEST X-RAY Described as reticulonodular pattern in the right lower lobe CHEST CT AND LUNG FUNCTION TESTS

  5. Radiology Predominance in lung basis Ground glass opacities Subpleural reticulation Bronchiolectasis Without honeycombs areas NONSPECIFIC INTERSTITIAL PNEUMONIA (NSIP)

  6. HISTORY OF PRESENTING ILLNESS LUNG FUNCTION TESTS Restrictive pattern, small airway obstruction and normal CO diffusion

  7. HISTORY OF PRESENTING ILLNESS 6 minute walking test Without suplementar O2 • Sat O2 95% »» 94% • HR 90 bpm »» 109 bpm • 450m (75%) • No interruption • Borg 0 »» 2

  8. HISTORY OF PRESENTING ILLNESS Salmeterol/fluticasone propionate 500/50 µg 2xday (Irregular use) PULMONOLOGY DEPARTMENT (MARCH 2013)

  9. PAST MEDICAL HISTORY • Non-smoker • No exposure to organic dust or other relevant exposures • No relevant respiratory disorders • “Arrhythmia” • 6 years before • β-blockers

  10. PAST MEDICAL HISTORY • Hyperlipidemia • 5 years before • HMG-CoA inhibitors (Statins) • Drug history • Simvastatin20mg/day (started 5 years before) • Bisoprolol5mg/day started 6 years before, but changed to Nebivolol 2 years ago

  11. PAST MEDICAL HISTORY • No history of foreign travel • No past of blood transfusions

  12. PHYSICAL EXAMINATION • Vital signs – BP 131/76, HR 64, oxygen saturation (air room) 97% • No signs of respiratory distress • No finger clubbing • Lung auscultation – crackles in the bases • Heart auscultation – normal • Abdomen – no hepatosplenomegaly • No peripheral adenopathy

  13. COMPLEMENTARY DIAGNOSTIC EXAMS BRONCHOFIBROSCOPY Diffusely hypervascularized mucosa BAL Normal total and differential cell count No malignant cells Negative microbiology

  14. COMPLEMENTARY DIAGNOSTIC EXAMS BLOOD IMMUNOLOGIC EVALUATION Negative

  15. PNEUMOTOX In: www.pneumotox.com

  16. PLAN SIMVASTATIN

  17. EVOLUTION 3M LATER RADIOLOGICALLY CLINICALLY No respiratory complaints, incluiding dyspnea, wheezing and dry cough

  18. EVOLUTION 6M LATER LUNG FUNCTION TESTS 6 MWT (without O2) • Sat O2 94% »» 94% • HR 112 bpm »» 93 bpm • 420m (70%) • No interruption • Borg 0 »» 0 Small airway obstruction and normal CO diffusion

  19. EVOLUTION 11M LATER Small airway obstruction

  20. FINAL DIAGNOSIS NONSPECIFIC INTERSTITIAL PNEUMONIA STATIN-INDUCED LUNG INJURY

  21. THANK YOU FOR YOUR ATTENTION!

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