RESEARCH - Diffuse alveolar damage: uncommon manifestation of pulmonary involvement in patients with connective tissue diseases

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Chest. 2006 Aug;130(2):553-8.

Diffuse alveolar damage: uncommon manifestation of pulmonary involvement in

patients with connective tissue diseases.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN

55905, USA.

BACKGROUND: Diffuse alveolar damage (DAD) is a relatively common finding on

surgical lung biopsy and can result from a variety of causes. METHODS: We

studied nine consecutive patients with connective tissue disease (CTD) and

DAD diagnosed on surgical lung biopsy to examine this association and

clinical implications. RESULTS: The median age was 63 years (range, 35 to 76

years), and seven of the patients were women (78%). Underlying CTDs included

rheumatoid arthritis in five patients, polymyositis in two patients, and one

patient each with systemic sclerosis and mixed CTD. In seven patients (78%),

CTD had been diagnosed before the onset of DAD; six of these patients had a

preexisting interstitial lung disease (ILD) related to their CTD. DAD was

the presenting manifestation leading to a new CTD diagnosis in two patients

(22%). CT of the chest revealed ground-glass opacities and/or consolidation

bilaterally with or without honeycombing. In all patients, surgical lung

biopsy revealed DAD for which no cause could be identified other than the

underlying CTD. Seven patients (78%) were receiving mechanical ventilatory

support at the time of the surgical lung biopsy. Four patients (44%)

survived to hospital discharge and included one patient with preexisting ILD

and all three patients without chronic ILD.

CONCLUSION: We conclude that DAD can complicate the clinical course of

patients with CTD-related chronic ILD, or can occasionally occur as a

presenting manifestation of CTDs. When DAD occurs in patients with CTDs, the

outcome appears to be worse for those with preexisting chronic ILD compared

to those without ILD.

PMID: 16899858

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16899858

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

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