Thursday, July 14, 2005

Follow up to Ground Glass? Sensei

I saw this patient again after his bronchoscopy and on more detailed questioning I discovered that he had a hot tub in his Karate studio and lived in the same building above his studio.

He underwent a surgical lung biopsy which revealed: interstitial granulomatous pneumonitis. Special stains were negative for pathogens.

The hot tub was removed from his home/studio and I offered him treatment with steroids which he declined. On 2 month follow up he had shown significant clinical improvement and some improvement in CT and DLCO. We again discussed treatment which he declined.

Dx: Hot tub lung

3 comments - CLICK HERE to read & add your own!:

Jennings said...

Cool case. Just curious - did the BAL cell count have a high cd8/cd4 ratio?

Jennings said...

BTW, there's no data that steroid therapy is effective except possibly in the acute early stages of HP. There's a paper, forget ref, that has a graph of improvement on y axis and time on x with time zero being steroid initiation or placebo. The steroid is better early on, but the two lines meet after something like 8-16 weeks.

DKeena said...

The CD4/CD8 ratio was actually high which is supposed to correspond with sarcoid. The biopsy however looked more like HP with alot of chronic inflammation and a few scattered granulomas.