Submitted by Dr LAU Chun Wing Arthur 2 January 2009
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
F / 76, housewife and lifelong non-smoker. Outgoing. History of hypertension and atrial fibrillation on diltiazem, methyldopa, and amiodarone.
Admitted in October 2001 with increasing SOB, cough productive of yellow sputum for 3/7. No fever, oedema or orthopnoea. Inspiratory course crepitations on auscultation of chest, no wheeze, SaO2 88% on 1LO2. No evidence of right heart failure.
CXR bilateral and extensive patchy consolidation. 8 hours after admission, desaturation with respiratory distress requiring mechanical ventilation. Treated as severe CAP with subsequent ARDS. But all bacterial and viral cultures were negative.
Chest condition did not improve with antibiotics treatment.
Therefore, HR CT thorax was done. HRCT 5/11/01 – multiple central and peripheral patchy shadows with air bronchogram.
Bronchoscopy 8/11/01 – Bilateral purulent secretions, TBBx compatible with acute interstitial pneumonia.
Response to prednisolone, cyclophosphamide and colchicines. Serial CXR (from 2001 – 2002): gradually resolution of lung infiltrates.
In summary
Acute interstitial pneumonitis presenting as “idiopathic ARDS”.