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Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology

Benoît Godbert, Marie-Pierre Wissler, Jean-Michel Vignaud
European Respiratory Review 2013 22: 117-123; DOI: 10.1183/09059180.00005812
Benoît Godbert
*CHU de Nancy, Pôle de spécialités médicales, Service de pneumologie, Nancy, and #CHU de Nancy, Pôle laboratoires, Service d’anatomo-pathologie, Nancy, France.
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  • For correspondence: benoit.godbert@hp-metz.fr
Marie-Pierre Wissler
*CHU de Nancy, Pôle de spécialités médicales, Service de pneumologie, Nancy, and #CHU de Nancy, Pôle laboratoires, Service d’anatomo-pathologie, Nancy, France.
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Jean-Michel Vignaud
*CHU de Nancy, Pôle de spécialités médicales, Service de pneumologie, Nancy, and #CHU de Nancy, Pôle laboratoires, Service d’anatomo-pathologie, Nancy, France.
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    Figure 1.

    Example of thin parenchymal section computed tomography findings in desquamative interstitial pneumonia: patchy ground-glass attenuation with a peripheral bilateral and almost symmetric distribution, and irregular and linear opacities.

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    Figure 2.

    a–c) This lung biopsy from a 55-year-old male patient, who was a nonsmoker, shows a typical desquamative interstitial pneumonia pattern. Tissue sections show a) diffuse involvement of the lung by intense macrophage accumulations within almost all of the distal airspace, b) without significant thickening of alveolar septa and sparse inflammatory infiltrate (*). Macrophages do not contain dusty pigment. c) Immunohistochemical analysis with CD163 antibody shows the macrophage nature of the cells. d–f) Lung biopsy from a 66-year-old female, who was a heavy smoker, showing a respiratory bronchiolitis/interstitial lung disease pattern. d) Macrophage accumulation is diffuse but predominantly peribronchiolar and f) in respiratory bronchioles. Alveolar septa are slightly thickened. e) The cytoplasm of most macrophages contains an abundant dust-brown pigment.

Tables

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  • Table 1. Epidemiological and clinical features of desquamative interstitial pneumonia
    Liebow [1]Tubbs [3]Yousem [5]Ryu [6]Total
    Cases n18263623103
    Males/females n10/817/926/1011/1264/39
    Age at onset years median (interquartile range)45 (16–63)51 (24–75)42 (17–67)46 (26–69)46 (16–75)
    Smoking historyns15/26 (58)30/33 (91)20/23 (87)65/82 (79)
    Mean smoking exposure pack-years (95% CI)≥1036 (10–71)31 (10–90)
    Occupational history, cases exposed1 exposed to plastic fumes and dusts
    2 exposed to hairsprays
    nsnsNo environmental exposure or underlying disease identified
    Symptoms
        Dyspnoea18/18 (100)23/26 (88.5)29/34 (85)20/23 (87)90/101 (89)
        Cough14/16 (87.5)18/26 (75)26/32 (81)10/23 (43)68/97 (70)
        Sputum4/16 (25)ns17/33 (52)ns21/49 (43)
        Weight loss6/10 (60)1/26 (4)nsns7/36 (20)
        Chest pain9/12 (75)1/26 (4)ns4/23 (17)14/61 (23)
        Haemoptysis1/18 (5.5)2/26 (8)nsns3/44 (7)
        Asymptomatic0/18 (0)1/26 (4)5/34 (15)1/23 (4)7/101 (7)
    Physical signs
        Cyanosis7/10 (70)3/26 (11.5)nsns10/36 (28)
        Crackles<50%17/26 (65)5/9 (56)13/23 (57)35/58 (60)
        Clubbing5/9 (55.5)#12/26 (46)15/36 (42)#6/23 (26)38/94 (40)
    • Data are presented as n/N (%), unless otherwise stated. ns: not specified. #: clubbing sometimes disappeared after steroid therapy.

  • Table 2. All causes implicated in desquamative interstitial pneumonia (DIP), other than tobacco smoking
    CausesRef.Comments
    Occupational exposure to inorganic particles[1, 2 8–10]Nature of particles: Si, Mg, Ti, Fe, Ni, Pb, Cr, Au, Ag, Al, K, Ti, BaS, Be, Cu
    Occupation: tool grinder, arc polisher, tyre manufacturing worker, plastic machinist, Al arc welder, worker exposed to fire-extinguisher powder, diesel fumes
    Exposure to mycotoxins[37–43]Occupational exposure to aflatoxin (textile worker)
    Connective tissue diseases[44, 45]
    Rheumatoid arthritis[46]
    Sirolimus[47]
    Infection[48–50]DIP following concurrent CMV and Aspergillus pneumonias in a renal transplant recipient (who did not receive sirolimus)
    Association of DIP and HCV infection
    Association of DIP and CMV infection in a baby
    Use of marijuana[51]
    • CMV: cytomegalovirus; HCV: hepatitis C virus.

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Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology
Benoît Godbert, Marie-Pierre Wissler, Jean-Michel Vignaud
European Respiratory Review Jun 2013, 22 (128) 117-123; DOI: 10.1183/09059180.00005812

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Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology
Benoît Godbert, Marie-Pierre Wissler, Jean-Michel Vignaud
European Respiratory Review Jun 2013, 22 (128) 117-123; DOI: 10.1183/09059180.00005812
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  • Article
    • Abstract
    • EPIDEMIOLOGICAL AND CLINICAL FEATURES
    • PULMONARY FUNCTION TESTS
    • BIOLOGICAL ANALYSES
    • RADIOLOGICAL FEATURES
    • HISTOLOGICAL FEATURES
    • AETIOLOGIES OF DIP
    • TREATMENT, RESPONSE TO TREATMENT AND PROGNOSIS
    • CONCLUSION
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  • Interstitial and orphan lung disease
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