open access
A case of an 81-year-old with cough and dyspnea
open access
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.
Keywords
unilateral UIP; GERD; hiatus hernia
About this articleTitle
A case of an 81-year-old with cough and dyspnea
Journal
Advances in Respiratory Medicine
Issue
Article type
Case report
Pages
454-457
Published online
2020-10-24
DOI
10.5603/ARM.a2020.0158
Pubmed
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)- 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.
- 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.
- Callahan SJ, Xia M, Murray S, et al. Clinical characteristics in patients with asymmetric idiopathic pulmonary fibrosis. Respir Med. 2016; 119: 96–101.
- Tcherakian C, Cottin V, Brillet PY, et al. Progression of idiopathic pulmonary fibrosis: lessons from asymmetrical disease. Thorax. 2011; 66(3): 226–231.
- 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.
- 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.
- 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.
- Abdulla O, Cain J, Howells J. Swyer-James-MacLeod syndrome with unilateral pulmonary fibrosis: a case report. BJR Case Rep. 2017; 3(4): 20160105.