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PubMed1987

Lymphoid interstitial pneumonia: clinicopathological and immunopathological findings in 18 cases.

Eighteen patients with lymphoid interstitial pneumonia (LIP) were studied. The diagnosis was established by the microscopic finding of interstitial infiltrates of lymphocytes and plasma cells. Forty-seven% of patients also had germinal centres, while 72% showed interstitial giant cells. Cases studied by the immunoperoxidase technique showed the interstitial plasma cells to be polytypic. The median age of patients was 56 years; most had cough, dyspnea, or chest pain. Chest X-rays showed either patchy interstitial infiltrates (usually bilateral) or poorly defined nodules. Ten patients had hypergammaglobulinemia; one had hypogammaglobulinemia. Two patients had Sjögren's syndrome, two had biopsy-proven chronic active hepatitis, and two had a clinical diagnosis of primary biliary cirrhosis. Follow-up examination of 14 patients showed clearing of symptoms, X-ray infiltrates or stable infiltrates in 4 cases each. Five patients died (mean survival, 41 months), one of whom succumbed to disseminated lymphoma and a second to respiratory failure. Our results support the hypothesis that LIP is a non-neoplastic cellular proliferation in which lymphoma may supervene. The high incidence (22%) of chronic liver disease has not previously been noted.

Adult↗
PubMed2004

[Lymphoid interstitial pneumonia resolved through antiretroviral therapy in an adult infected by human immunodeficiency virus].

Lymphoid interstitial pneumonia (LIP) is a rare entity characterized by the infiltration of interstitial tissues and alveolar spaces by lymphocytes, plasma cells, and other lymphoreticular structures. The etiology of LIP is unknown, although associations with autoimmune and infectious factors have been described. The incidence of LIP has risen in recent years, mainly in children with acquired immunodeficiency syndrome (AIDS), while remaining less common in the adult population. No agreement has been reached regarding the diagnostic tests necessary for a firm diagnosis although suspicion is usually based on clinical and radiographic findings, with confirmation provided by examination of histological samples. The most common treatment is corticosteroids, either alone or in combination with other immunosuppressant agents although no evidence from controlled trials is available and cases have been reported in which LIP resolved in AIDS patients with antiretroviral therapy alone. We report the case of a human immunodeficiency virus-infected adult who was diagnosed with LIP by open lung biopsy and who responded to antiretroviral drugs with no need for associated corticosteroid therapy.

Anti-Retroviral Agents↗
PubMed1981

Acute experimental canine ehrlichiosis. I. Sequential reaction of the hemic and lymphoreticular systems.

Dogs with acute Ehrlichia canis infection showed the established clinical features of acute ehrlichiosis and had thrombocytopenia, anemia, increased serum glutamic pyruvic transaminase activity, and decreased total serum protein and albumin concentrations during the first weeks after infection, and increasing gamma globulin concentrations after the third week. Gross lesions in hemic and lymphoreticular tissues were transient lymphadenomegaly, splenomegaly, and increased red long-bone marrow. Lymphoreticular hyperplasia in the paracortical area of lymph nodes and in the splenic red pulp occurred during the second week of infection. Later, small lymphocytes were replaced by medium-sized lymphocytes and plasma cells. Activity of germinal centers increased initially, as shown by numerous mitotic figures and macrophages, but diminished later, and the follicles blended with interfollicular and paracortical tissue because of a decrease in small lymphocytes in the mantle layer. We saw splenic hemorrhages near the perifollicular sinus, and vasculitis, most often phlebitis, in the kidney between weeks 2 and 4. Multifocal reticuloendothelial hyperplasia occurred in the liver during the early stage and injured adjacent hepatocytes by compression. Lesions typical of ehrlichiosis in these dogs were interstitial pneumonia, subendothelial aggregates of mononuclear cells in pulmonary blood vessels, renal periglomerular and perivenular plasmacytosis, hemopoietic hyperplasia, and perivascular cuffs of lymphocytes and plasma cells in many organs.

Acute Disease↗
PubMed1988

Primary pulmonary lymphoma: a re-appraisal of its histogenesis and its relationship to pseudolymphoma and lymphoid interstitial pneumonia.

The clinical, morphological and immunohistochemical features of 15 cases of pulmonary lymphoproliferative disease are described. The diagnosis of primary pulmonary lymphoma was based in 13 cases on the demonstration of light chain restriction and in two cases on morphological characteristics. Many patients had a prolonged clinical course without significant clinical or radiographic deterioration, a feature associated with malignant lymphomas of mucosa-associated lymphoid tissue in other sites. Lymphoepithelial lesions were characteristic and malignant cells had the features of centrocyte-like cells, similar to those described in gastric and salivary gland lymphomas. Germinal centres were present in three cases: some were partially overgrown by centrocyte-like cells but residual polyclonal follicle centre cells and dendritic reticulum cells were still detectable. It is suggested that primary pulmonary lymphoma arises from centrocyte-like cells normally present in bronchus-associated lymphoid tissue. In addition to the malignant population, reactive follicles and polytypic plasma cells are frequently present and may prejudice interpretation of immunohistochemical features. In the light of these findings, cases previously diagnosed as pseudolymphoma or lymphoid interstitial pneumonia require careful assessment and the majority are, in reality, examples of primary pulmonary lymphomas.

Adult↗
PubMedDate not supplied

Chronic granulomatous pneumonia and lymphocytic responses induced by inhaled beryllium metal in A/J and C3H/HeJ mice.

Inhalation of beryllium (Be) has been associated with 2 syndromes: an acute chemical pneumonitis and a granulomatous lung disease known as chronic beryllium disease (CBD). Key to the pathogenesis of CBD is a delayed-type hypersensitivity reaction, in which Be most likely functions as a hapten and acts as a Class II-restricted antigen, stimulating local proliferation and accumulation in the lung of Be-specific CD4+ T cells. The purpose of this study was to establish a mouse model of CBD using the inhalation route of exposure. A/J (H-2a haplotype) and C3H/HeJ (H-2a) mice were exposed once for 90 min in nose-only exposure tubes to aerosols of Be metal. Six mo later, lung histopathologic responses were assessed. Further analyses defined the phenotypic profile of lymphocytes in pulmonary lesions and evaluated proliferation of lymphocytes in situ and in response to Be in vitro. Responses were similar in both strains of mice. The lungs of all Be-exposed mice had interstitial compact aggregates of lymphocytes, and granulomatous pneumonia characterized by vacuolated macrophages and giant cells in alveoli, neutrophils in alveoli and alveolar septa, multifocal interstitial granulomas, and interstitial infiltrates of lymphocytes, plasma cells, monocytes, and macrophages. Most Be-exposed mice had minimal to mild interstitial fibrosis. The majority of lymphocytes in interstitial infiltrates and in microgranulomas were CD4+ T cells. Interstitial compact aggregates of lymphocytes contained B cells centrally and CD4+ cells peripherally. Lymphocyte labeling indices, used to assess proliferation in situ, were significantly greater within microgranulomas compared to compact lymphocytic aggregates. Lymphocyte stimulation indices in response to BeSO4 in vitro were not positive in blood, spleen, or tracheobronchial lymph node samples. Be-specific immune responses and nonspecific inflammatory responses to toxic and foreign-body properties of Be may have contributed to the histopathology in both strains of mice. The interstitial mononuclear cell infiltrates, presence of microgranulomas, multinucleated foreign-body and Langhans' giant cells, interstitial fibrosis, and CD4+ T-cell predominance with local proliferation are features similar to CBD in humans. The chronic lung disease induced in these mice by inhaled Be can be used to investigate the importance of variables such as dose, exposure pattern, and physicochemical form of Be in producing this disease.

Administration, Inhalation↗
PubMed2001

Pathogenesis of SIV pneumonia: selective replication of viral genotypes in the lung.

Lymphocytic interstitial pneumonia of HIV-infected individuals and SIV pneumonia of macaques are both characterized by diffuse infiltration of the lungs with lymphocytes, plasma cells, and macrophages. This study was undertaken to determine whether there are specific, macrophage-tropic genotypes that selectively replicate in the lung of macaques with SIV pneumonia, as in SIV encephalitis. Using a rapid, reproducible SIV/macaque model of AIDS, 11 pig-tailed macaques were intravenously inoculated with an immunosuppressive viral strain, SIV/DeltaB670, and a macrophage-tropic molecule clone, SIV/17E-Fr, and euthanized at 3 months postinoculation. All 11 macaques had severe (6 macaques) or moderate (5 macaques) pneumonia. To identify the viral genotypes that were replicating in the lung parenchyma, bronchoalveolar lavage (BAL) cells, and peripheral blood mononuclear cells (PBMC) of each macaque, RNA was isolated and the SIV env V1 region was amplified, cloned, and sequenced. Lung homogenates and BAL cells contained a more limited repertoire of viral genotypes than PBMC. SIV/17E-Fr was the major genotype in the lungs of 5 macaques and in BAL cells of 6 macaques. The remainder of the macaques had SIV/17E-Fr and the macrophage-tropic strains of SIV/DeltaB670 clones 2 and 12. In contrast, SIV/17E-Fr was the predominant strain in the PBMC of only 3 of 11 macaques. The viral strain that predominated in PBMC was rarely the strain that predominated in the lungs (only 3 of 11 macaques). The severity of pulmonary lesions did not correlate with the levels of viral RNA in lung homogenates or in plasma. However, when only SIV/17E-Fr was expressed in the lung, the viral load in the lung was significantly higher (P = 0.016) than when SIV/DeltaB670 was present alone or in combination with SIV/17E-Fr. These data suggest that SIV pneumonia is associated with selective replication of specific macrophage-tropic genotypes in the lung and that SIV/17E-Fr has a selective advantage for replication in the lung.

Amino Acid Sequence↗
PubMed2006

Lymphocytic interstitial pneumonitis (LIP) in Sjögren's syndrome: a case report and a review of the literature.

Sjõgren's disease is one of the most common rheumatological diseases and can present with a variety of extra-glandular manifestations. Lymphocytic Interstitial Pneumonitis (LIP) is the most common lung pathology in these patients. It is important to know and recognize this condition because it is potentially treatable. It is also frequently misdiagnosed and treated as infectious pneumonia multiple times before the correct diagnosis is made. It is a benign lymphoproliferative disorder characterized histologically by interstitial infiltration with polyclonal lymphocytes and plasma cells. High-resolution CT scan of the lungs shows extensive areas of ground-glass attenuation and interlobular septal thickening with scattered thin-walled cysts. An open-lung biopsy is the best method of diagnosing this condition, as less invasive techniques do not provide an adequate tissue specimen. LIP occurs in a wide variety of settings such as autoimmune disease, HIV disease, and as an adverse reaction to some medications; it is, therefore, considered to be a nonspecific response to many stimuli. The treatment usually consists of corticosteroids and other immunosuppressants, though there have been no controlled trials to date. Establishment of a registry may help better evaluate and treat this disease. We present the case of a patient who was diagnosed with LIP secondary to Sjögren's syndrome and also review the literature available.

Adolescent↗
PubMed2006

Inflammatory cell phenotyping of the pulmonary interstitium in idiopathic interstitial pneumonia.

BACKGROUND: Several studies have implicated the role of inflammation in the pathogenesis of lung damage in idiopathic interstitial pneumonias (IIPs). Investigations of inflammatory cells in IIP have show that eosinophils, neutrophils and T cells may be associated with a poorer prognosis. OBJECTIVES: The aim of our study was to map, by quantitative analysis, the number of inflammatory cells in the lung tissue of patients with non-specific interstitial pneumonia/non-specific interstitial pneumonia (NSIP/NSIP), acute interstitial pneumonia/diffuse alveolar damage (AIP/DAD) and idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP) and to correlate them with lung function tests and survival. METHODS: After immunohistochemical staining, we quantified the content of inflammatory cells [macrophages, neutrophils (elastase+), plasma cells, and CD3, CD4 and CD8 T lymphocytes (TLs)] in 20 NSIP, 20 DAD and 20 UIP surgical lung biopsies. RESULTS: The total density of inflammatory cells was significantly increased in DAD and NSIP when compared to UIP (p = 0.04). TLs were increased in DAD and NSIP when compared to UlP lungs (p < 0.05). The density of inflammatory cells in UIP showed significant differences in normal, intervening and dense fibrosis areas (p < 0.05). The most numerous cells infiltrating the mural fibrosis and honeycombing areas were plasma cells, neutrophils (elastase+), CD20+, CD3+, CD4+ and CD8+ (p < 0.05). In UIP, CD3+ TLs were directly correlated with forced expiratory volume in 1 s/forced vital capacity ratio x 100 (p = 0.05). CD68+ cells presented a significant positive correlation with the forced expiratory volume in 1 s (p = 0.04); neutrophil (elastase+) cells significantly correlated with residual volume (p = 0.02), residual volume/total lung capacity (p = 0.04) and carbon monoxide transfer factor (p = 0.03). The most important predictor of survival in UIP was CD3+ TLs (p = 0.05). CONCLUSION: The total density of inflammatory cells and lymphocytes presents a different distribution within the pulmonary parenchyma in AIP/DAD, NSIP/NSIP and IPF/UIP evolutionary adapted responses to injury. There is a localized distribution of inflammation in the normal, intervening and dense fibrosis areas of UIP for CD3+, associated with a lethal deterioration of the pulmonary function and poor survival. Our findings provide further evidence of the importance of inflammation in the pathophysiology of IIPs.

Adult↗
PubMed1998

[Effect of selenium status on the morbidity of interstitial pneumonia in rats infected with mycoplasma].

To investigate the effect of selenium(Se) status on morbidity and process of interstitial pneumonia, we used the Wistar rats as the animal model infected with Mycoplasma Pneumonia (MP). The rats were maintained on the based diets with different doses of Se, infected with MP and exposed to sodium selenite(1.5-2.0 ml/day, containing Se 2 micrograms/ml) or 0.9% NaCl (1.5-2.0 ml/d) by gavage for different time. The experimental rats were divided into five groups, group A, feeding with normal control diet and without infected MP, group B with adequate Se diet and infected MP, group C with Se deficiency diet infected MP and added Se at the same time, group D with Se deficiency diet and added Se after suffered with MP, and group E with Se deficiency diet and infected MP. The results showed that the MP morbidity of the rats fed with high Se diet was significantly lower than that of the rats fed with low Se diet. The pathological change was significant in the low Se group and relatively mild in the high Se group. After infected with MP, the supplementation of sodium selenite to the low Se rats might decrease the MP morbidity and shorten the disease course compared with the group without supplementing Se. The incidence of myocarditis in the infected group with normal Se level diet or in the infected group with Se supplement was lower than that in the group without Se supplementation. The concentrations of Se in plasma and glutathione peroxidase in plasma and white blood cells decreased to a certain level after infection. The present study indicated a positive influence of Se supplement on the morbidity, disease course, and state of interstitial pneumonia in rats.

Animals↗
PubMed2003

[Pulmonary actinomycosis mimicking of mucosa-associated lymphoid tissue lymphoma by frozen section examination: report of a case].

A 59-year-old man was admitted to our hospital for hemoptysis. Chest X-ray films showed a mass shadow in the left lower lobe. Any definitive diagnosis could not be made after examinations including sputum culture and bronchial cytology. Exploratory thoracotomy was performed since malignancy was not excluded. During the operation, mucosa-associated lymphoid tissue (MALT) lymphoma was suspected based on the pathological findings of the frozen section. The permanent section of the resected specimen contained colonies of actinomycetes in the bronchus, and the peripheral region demonstrated marked infiltration of lymphocytes and plasma cells through the interstitium of alveolar walls and peri-bronchovascular sheath, with many lymphoid follicles. This case revealed pulmonary actinomycosis coexisted with lymphocytic interstitial pneumonia (LIP). We concluded that lymphoproliferative disease should be considered another candidate for the differential diagnosis from pulmonary actinomycosis.

Actinomycosis↗
PubMed1992

A familial lymphoproliferative disorder presenting with primary pulmonary manifestations.

A familial lymphoproliferative disorder presented in three male siblings with primary pulmonary involvement manifested as either lymphoid interstitial pneumonia or an angiodestructive polymorphous infiltrate morphologically resembling lymphomatoid granulomatosis. The polymorphous infiltrate consisted chiefly of mature T-cells with a few B-cells and plasma cells, and gene rearrangement studies failed to show clonality. Epstein-Barr virus, frequently associated with proliferative lesions in males in the X-linked lymphoproliferative syndrome, was not demonstrated in any of the pulmonary lesions. An HLA haplotype shared among the affected siblings was A1, B8, DR4. The unusual clinical presentation plus the lack of involvement by EBV in the pulmonary lesions suggests that this is a previously undescribed familial lymphoproliferative disorder.

Adolescent↗
PubMed1986

[AIDS complications of the lung].

AIDS represents a virus-induced disturbance of the cell-determined immunity which is seen in ever increasing numbers of cases even in Europe. AIDS occurs in certain risk groups. Clinically the first symptoms of the disease which are seen are pulmonary, bouts of fever, unproductive coughing, dyspnoea whilst dullness, bronchospasmus and an increase in sputum production are rare. Interstitial infiltrates do not contain plasma cells. In X-ray pictures striped shadows, atypical lobular infiltrates and pleural fluid are not uncommon as is also the case in other atypical pneumonias. As a rule the pulmonary function-test shows a reduced DCO but this is not specific.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Evaluation of the elastase burden in patients with idiopathic interstitial pneumonia].

This study was designed to clarify the role of neutrophil elastase in the pathogenesis of idiopathic interstitial pneumonia (IIP). To accomplish this, elastase: alpha 1-antitrypsin complexes in plasma and bronchoalveolar lavage fluids (BALF) were measured in 19 patients with IIP and compared to 15 normal smokers. Cell differentiation counts showed that there was no difference in percent neutrophils in BALF between IIP patients and normal smokers. However, elastase: alpha 1-antitrypsin complexes were significantly increased in both plasma and BALF in patients with IIP compared to normal smokers. In IIP patients with honeycombing demonstrated by high resolution CT, although elastase: alpha 1-antitrypsin complexes were not significantly increased in plasma, elastase: alpha-antitrypsin complexes in BALF were significantly increased compared to IIP patients without honeycombing. Western immunoblot analysis showed that although the native 80-KD elastase: alpha-antitrypsin complex was detected in BALF, the molecular weight of elastase: alpha 1-antitrypsin complex in plasma was 60-KD.

Aged↗
PubMed1977

Ultrastructure of lymphoid interstitial pneumonia: virus-like particles in bronchiolar epithelium of a patient with Sjögren's syndrome.

Ultrastructural studies of an open lung biopsy of a patient who had lymphoid interstitial pneumonia, Sjögren's syndrome, and a highly elevated level of immunoglobulin M in the serum disclosed the presence in bronchiolar epithelium of numerous round electron-dense particles 70-120 nm in diameter. These were closely reminiscent of the oncogenic type-A viral particles associated with tumors of laboratory and wild mice. In the inflammatory infiltrate the morphology of some small lymphocytes was suggestive of germinative activity, although no germinal centers were found. Plasma cells, which were numerous in the vicinity of the bronchiolar epithelium, contained varying amounts of electron-dense material, probably immunoglobulin, which was also deposited in the irregulary thickened epithelial basal lamina. The observations support the theory that viral infection may be the stimulus to the immunologic abnormalities observed in patients with lymphoid interstitial pneumonia and Sjögren's syndrome.

Bronchi↗
PubMed1988

Respiratory disease and wasting in athymic mice infected with pneumonia virus of mice.

Although pneumonia virus of mice (PVM) is ubiquitous among rodent colonies in the United States, it has not been reported to cause clinically apparent disease in euthymic mice. However, PVM has been reported to cause respiratory disease and death in experimentally infected euthymic and athymic mice. A group of nu/nu mice, housed in quarantine in a Trexler-type isolator, had weight loss and dyspnea. Gross necropsy findings included cachexia and diffuse pulmonary edema or lobar consolidation. Histologically there was diffuse interstitial pneumonia. Electron microscopy revealed filamentous virions budding from plasma membranes, and immunohistochemical staining of lung tissue was positive for PVM antigen. PVM was isolated from affected lung tissue in BHK 21 cells and mouse antibody production tests resulted in seroconversion to PVM. Experimental inoculation of athymic mice with lung homogenate from spontaneously infected mice resulted in clinically apparent respiratory disease and histologic lung changes similar to those in naturally infected mice. Inoculation of athymic mice with infected BHK 21 cell culture fluid resulted in pneumonia which was qualitatively similar to, but less severe than, that observed in mice with spontaneous disease. These findings indicate that naturally occurring PVM infection in athymic mice may cause respiratory disease and wasting.

Animals↗
PubMed1990

Inflammatory pseudotumor of the lung in a child with mycoplasma pneumonia.

A case of inflammatory pseudotumor of the lung occurring in a six-year-old boy is reported with clinicopathologic findings, including its ultrastructure. The patient had had frequent upper respiratory tract infections, and one and half year before the discovery of the lung mass, he suffered from pneumonia of the right lung, which was serologically proven to be a mycoplasma pneumoniae infection. Exploratory thoracotomy revealed a large mediastinal mass that was removed together with the right middle and lower lobes of the lung. The mass arose from the lung with an endobronchial element. Microscopically, the mass was composed of a variety of inflammatory and mesenchymal cells, including plasma cells, histiocytes, lymphocytes, and fibroblast-like spindle cells. Ultrastructurally, the spindle-shaped mesenchymal cells were either fibroblasts or myofibroblasts. At the time of diagnosis of the inflammatory pseudotumor of the lung, the serum titer of antimycoplasma antibody rose again, and the lung parenchyma adjacent to the mass showed interstitial pneumonia with features of bronchiolitis obliterans. The present case suggests that the inflammatory pseudotumor of the lung could be a postinflammatory lesion associated with mycoplasma pneumoniae infection.

Antibodies, Bacterial↗