Pulmonary histologic manifestation of Sjogren syndrome include nonspecific interstitial pneumonia , organizing pneumonia , usual interstitial pneumonia , lymphocytic interstitial pneumonia, primary pulmonary lymphoma , non caseating granuloma, bronchiolitis and diffuse interstitial amyloidosis. Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern characterized by intra-alveolar fibrin deposition and associated organizing pneumonia. AFOP has been associated with rheumatologic disorders in the literature but has not been described in association with Sjogren’s syndrome. We present a case of a 75 year old female with history of Sjogren’s syndrome who was not compliant with her medications. She presented to our clinic …show more content…
The histological pattern are devoid of hyaline membrane, eosinophils, granulomatous inflammation or extensive pneumonia or abscess1. Other minor features include acute or chronic inflammation, type 2 pneumocyte hyperplasia and alveolar expansion with myxoid tissue1. This entity was first published by Beasley et al in 2002. The case of 17 patients showed male and Caucasian predominance with average age of 62 years. Average time to onset of symptoms was 19 days, and the most common symptoms includes cough, shortness of breath and constitutional symptoms like fatigue or malaise1. AFOP etiology could be idiopathic or due to a wide range of medical conditions including rheumatologic diseases like systemic lupus erythematous, ankylosing spondylitis, polymyositis, polymyalgia and juvenile dermatomyositis 1,2. Sjogren’s syndrome is a slowly progressive autoimmune disorder that affect many organ systems. Patients with Sjogren’s syndrome represent about 2 percent of the population and most commonly present with symptoms related to diminished lacrimal and salivary gland function 3. Pulmonary involvement in Sjogren’s syndrome is common. Histological pattern seen include nonspecific interstitial pneumonia , organizing pneumonia , usual interstitial pneumonia ,
"Rheumatoid joint inflammation is an interminable infection set apart by irritation of the joints, frequently influencing the hand joints and both sides of the body in the meantime" (Royal Australian College of General Practitioners, 2009).
EH is a 68-year-old male who comes into the clinic complaining of a fever with a temperature of 103 °F. He has had a cough for the last three days that is producing some thick green brown mucous. The MD feels he most likely has bacterial pneumonia. He also has a history of having rheumatoid arthritis, and being immune compromised as he is on an immunosuppressant methotrexate. He has noted that over the last year he has lost weight unintentionally and feels he is underweight.
Lungs – Mucus plugging, chronic bacterial infections, pronounced inflammatory response, damaged airways leading to respiratory insufficiency, progressive decline in pulmonary function.
D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. He has had pneumonia yearly for the past 3 years, and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is an acute
This paper explores Pneumonia and the respiratory disease process associated with bacterial and viral pathogens most commonly located in the lung. The paper examines the process, symptoms and treatments most commonly viewed in patient cases of Pneumonia. My goal is to educate the reader and to warn of the
R.W. appears with progressive difficulty getting his breath while doing simple tasks, and also having difficulty doing any manual work, complains of a cough, fatigue, and weight loss, and has been treated for three respiratory infections a year for the past 3 years. On physical examination, CNP notice clubbing of his fingers, use accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs, and also pulmonary function studies show an FEV1 of 58%. These all symptoms and history represented here most strongly indicate the probability of chronic obstructive pulmonary disease (COPD). COPD is a respiratory disease categorized by chronic airway inflammation, a decrease in lung function over time, and gradual damage in quality of life (Booker, 2014).
History of Present Illness: Ms. Manock is a very pleasant 60-year-old woman with a history of severe COPD. She was previously seen by Elvira Aguila, MD. Her last office visit was in February 2015. Since that time, she states that over the last few weeks, she feels her dyspnea has worsened which is a result of increased humidity, which is normal for her. She has had a stable cough over the last six months, which is intermittently productive of sputum. She is using her supplemental oxygen at 2 L/minute with exertion and with sleep. She also notes postnasal drip, which is related to seasonal allergies.
Pneumonia is an inflammation of the lung which results into an excess of fluid or pus accumulating into the alveoli of the lung. Pneumonia impairs gas exchange which leads to hypoxemia and is acquire by inhaling a contagious organism or an irritating agent. (Ignatavicius & Workman, 2013). Fungal, bacteria and viruses are the most common organisms that can be inhale. Pneumonia could be community-acquired or health care associated. Community –acquired pneumonia (CAP) occurs out of a healthcare facility while health care associated pneumonia (HAP) is acquired in a healthcare facility. HAP are more resistant to antibiotic and patients on ventilators and those receiving kidney dialysis have a higher risk factor. Infants, children and the elderly also have a higher risk of acquiring pneumonia due to their immune system inability to fight the virus. Pneumonia can also be classified as aspiration pneumonia if it arises by inhaling saliva, vomit, food or drink into the lungs. Patients with abnormal gag reflex, dysphagia, brain injury, and are abusing drug or alcohol have a higher risk of aspiration pneumonia (Mayo Clinic, 2013). In the case of patient E.O., this patient had rhonchi in the lower lobe and the upper lobe sound was coarse and diminished. Signs and symptoms of pneumonia include difficulty breathing, chest pain, wheezing, fever, headache, chills, cough, confusion, pain in muscle or
Primary Sjögren’s syndrome (pSS) is a multisystem autoimmune disorder that induced dryness of the eyes (xerophthalmia) and mouth (xerostomia); salivary gland lesions and dysfunction; also the presence of autoantibodies including anti- Sjogren’s syndrome (SSA) and/or rheumatoid factor (RF).1,3 Primary Sjögren’s syndrome occurs in the absence of other underlying rheumatic disorder while secondary Sjögren’s syndrome is linked with another underlying rheumatic disease, such as mixed connective tissue disease, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), or scleroderma.2,10 In Sjögren’s syndrome all structures and organs of the body may be involved .This disease commonly affected the eyes,
A symptom of this autoimmune system disease includes tender and warm, swollen joints, usually in the smaller joints of your body.
This disease may be characterised by abundant thick, green/yellow sputum daily (months to years duration) and episodic haemoptysis. A risk factor is recurrent bronchopneumonia. Alternatively, increased mucus production suggests asthma, as increased mucus secretion contributes to the viscid mucous plugs that occlude asthmatic airways (Frieri, 2005). A further differential diagnosis is pulmonary oedema, where acute left ventricular failure (LVF) with pulmonary venous hypertension and alveolar flooding which causes blood-tinged sputum (Kelly, 1999). If LV filling pressure increases suddenly, plasma fluid moves rapidly from pulmonary capillaries into interstitial spaces and alveoli (Kelly, 1999). The haemoptysis/purulent sputum may also be caused by chronic lung abscesses.
pneumoniae and there chemotactic signals and the host cell’s alternate pathway, invade the alveoli. Also red blood cells are recruited to this site. In the third stage, mostly neutrophils are packed into the alveoli and very few bacteria remain. In the final stage, macrophages eliminate the remaining residue from the inflammatory response. As one can see, the damage which is done to the lung is largely a result of the host’s inflammatory response, which causes the build up of fluids in the lungs. If S. pneumoniae is allowed to persist in the lungs it can then invade the blood, which causes bacteremia. When in the blood it can traverse the blood-brain barrier and infect the meninges, which results in meningitis. S. pneumoniae is also associated with diseases in other parts of the respiratory tract including the paranasal sinuses, which is better known as sinusitis, and the middle ear can become infected, which is known as otitis media. It has also been known to cause peritonitis, an inflammation of the peritoneum, the membrane that lines the abdominal wall, and it is also implicated in causing arthritis.
Mrs. A (pseudonym) is an 83-year-old Samoan female of Christian religion who was admitted to an urban hospital on 02/04/15 by GP referral. She came in with chest pain associated with productive cough and shortness of breath (SOB) on exertion. She also complained of having recurrent episodes of vomiting mixed with saliva and fatigue. She has a history of asthma, hypertension, type 2 diabetes mellitus on Metformin and double incontinence due to a long-standing history of intermittent constipation. Her chest computed tomographic (CT) revealed right lower lobe opacity indicating pulmonary consolidation, which means that her right lower lung has accumulated exudates in the alveoli that would have normally been filled by gas, indicative of bacterial pneumonia. Furthermore, a sputum gram stain sample collected from Mrs. A showed gram-positive bacteria, which is also a characteristic of pneumonia. Her blood tests revealed a high haemoglobin count, which may be caused by an underlying lung disease, as well as high white blood cell count confirming the presence of infection. Considering all diagnostic results, Mrs. A was diagnosed with right lower lobe bacterial pneumonia.
"The common clinical features among the case-patients included a prodromial illness of fever, chills, and myalgia. The prodrome was followed by dyspnea, cough, throbocytopenia, severe hemodynamic instability, neutrophilid with immature forms, atypical lymphocytes, elevated serum levels of lactate dehydrogenase. There was a high mortality rate, approximately eighty percent in the initial group of patients, the chest x-ray examinations revealed a diffuse, interstitial infiltrate that resembled that observed in patients with adult respiratory distress syndrome (ARDS), which is a common pattern in patients
The clinical manifestations of pneumonia will be different according to the causative organism and the patient’s underlying conditions and/or comorbidities (Smeltzer, et al). Some of the manifestations are