open access

Vol 88, No 5 (2020)
Case report
Submitted: 2020-02-20
Accepted: 2020-05-07
Published online: 2020-10-24
Get Citation

A case of an 81-year-old with cough and dyspnea

Nitesh Gupta1, Abanti Das1, Pranav Ish1, Rohit Kumar1, Ankit Sharma1, Shibdas Chakrabarti1
DOI: 10.5603/ARM.a2020.0158
·
Pubmed: 33169819
·
Adv Respir Med 2020;88(5):454-457.
Affiliations
  1. Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India

open access

Vol 88, No 5 (2020)
CASE REPORTS
Submitted: 2020-02-20
Accepted: 2020-05-07
Published online: 2020-10-24

Abstract

It is uncommon to diagnose usual interstitial pneumonitis as a unilateral presentation. We present a case of an 81-year-old current smoker who presented with exertional dyspnea and dry cough. The patient had right sided UIP pattern in the CT chest along with hiatus hernia. The etiology for the unilateral lung involvement was postulated to be due to the hiatus hernia leading to gastro-esophageal reflux disease (GERD) which caused micro aspirations leading to lung injury and fibroblast activation. Whether this can be prevented by anti-reflux medications needs further research. Our patient was managed with pirfenidone, metered dose inhalers containing tiotropium and proton-pump inhibitors Thus, a high index of suspicion for underlying gastro-esophageal reflux must be kept in such patients to arrive at an early diagnosis and start treatment.

Abstract

It is uncommon to diagnose usual interstitial pneumonitis as a unilateral presentation. We present a case of an 81-year-old current smoker who presented with exertional dyspnea and dry cough. The patient had right sided UIP pattern in the CT chest along with hiatus hernia. The etiology for the unilateral lung involvement was postulated to be due to the hiatus hernia leading to gastro-esophageal reflux disease (GERD) which caused micro aspirations leading to lung injury and fibroblast activation. Whether this can be prevented by anti-reflux medications needs further research. Our patient was managed with pirfenidone, metered dose inhalers containing tiotropium and proton-pump inhibitors Thus, a high index of suspicion for underlying gastro-esophageal reflux must be kept in such patients to arrive at an early diagnosis and start treatment.

Get Citation

Keywords

unilateral UIP; GERD; hiatus hernia

About this article
Title

A case of an 81-year-old with cough and dyspnea

Journal

Advances in Respiratory Medicine

Issue

Vol 88, No 5 (2020)

Article type

Case report

Pages

454-457

Published online

2020-10-24

DOI

10.5603/ARM.a2020.0158

Pubmed

33169819

Bibliographic record

Adv Respir Med 2020;88(5):454-457.

Keywords

unilateral UIP
GERD
hiatus hernia

Authors

Nitesh Gupta
Abanti Das
Pranav Ish
Rohit Kumar
Ankit Sharma
Shibdas Chakrabarti

References (8)
  1. Raghu G, Freudenberger TD, Yang S, et al. High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis. Eur Respir J. 2006; 27(1): 136–142.
  2. Sweet MP, Patti MG, Leard LE, et al. Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation. J Thorac Cardiovasc Surg. 2007; 133(4): 1078–1084.
  3. Callahan SJ, Xia M, Murray S, et al. Clinical characteristics in patients with asymmetric idiopathic pulmonary fibrosis. Respir Med. 2016; 119: 96–101.
  4. Tcherakian C, Cottin V, Brillet PY, et al. Progression of idiopathic pulmonary fibrosis: lessons from asymmetrical disease. Thorax. 2011; 66(3): 226–231.
  5. Chong S, Kim TS, Chung MP, et al. Unilateral usual interstitial pneumonia associated with sarcoma of the pulmonary artery. AJR Am J Roentgenol. 2007; 189(4): W221–W223.
  6. Lesnyak VN, Danilevskaya OV, Averyanov AV, et al. Unilateral pulmonary fibrosis and systemic sclerosis. Am J Respir Crit Care Med. 2014; 190(9): 1067–1068.
  7. Takahashi T, Satoh M, Satoh H. Unilateral acute exacerbation of pulmonary fibrosis in association with Sjögren's syndrome. Intern Med. 1996; 35(10): 811–814.
  8. Abdulla O, Cain J, Howells J. Swyer-James-MacLeod syndrome with unilateral pulmonary fibrosis: a case report. BJR Case Rep. 2017; 3(4): 20160105.

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