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Interstitial Lung Disease(Sarcoidosis) : 

Interstitial Lung Disease(Sarcoidosis) The Case Study Review of Mr. J

Abstract : 

Abstract This is the case study of Mr. J, a 28-year-old male diagnosed with Sarcoidosis, a rare disease that is classified with a group of about 200 diseases known as Interstitial Lung Disease (ILD). Sarcoidosis and idiopathic pulmonary fibrosis are the 2 most common diseases, accounting for 50% of all cases. This presentation follows the course of Mr. J’s evaluation, diagnosis, and treatment over the period of one year from his initial doctor’s appointment.

Interstitial Lung Disease : 

Interstitial Lung Disease Made up of a large group of diverse diseases that cause lung damage that results in fibrosis of the lung and reduced lung volumes and lung area Types of interstitial lung disease are classified based on identifying the etiology of the disease Many patients who develop ILD do so as a result of harmful dusts, such as asbestos, silica, coal and talc Often times, ILD occurs with no identifiable etiology

Interstitial Lung Disease, cont’d : 

Interstitial Lung Disease, cont’d In the United States, it is estimated that as many as 81 of every 100,000 people have some form of ILD Only about one third of patients with ILD have an identifiable agent responsible for inducing lung injury Typical inorganic dusts that may induce ILD include asbestos, silica and talc These agents injure the epithelium or endothelium of the lung directly via or a toxic effect or indirectly by leading to the production of toxic membranes or activating an immune response

Slide 6: 

Injury Inflammation Disordered Repair of Lung Tissue Pulmonary Fibrosis End-Stage Lung Disease

Medical History : 

Medical History Mr. J is a 28-year-old African American male employed as a savings-and-loan computer analyst CC: increasing fatigue over the span of several months HPI: Progressed the point that he stopped jogging and felt listless and tired most of the time This began as a flu-like illness and left him with a non-productive cough Mr. J denies fever, chills, sore throat, coryza, headaches, or wheezing He notes dyspnea on exertion, but denies awakening with breathlessness or having dyspnea at rest

Past Medical History : 

Past Medical History Positive for chickenpox, but no measles or mumps No surgical history, but broke his leg at age 22 secondary to a skiing accident SH: No history of tobacco or illicit drug use; reports ETOH consumption socially FH: Mother with HTN, but father is healthy He has two children with no remarkable health problems

Slide 9: 

GENERAL: Athletic-appearing man in no respiratory distress. V/S: 97.3°F, pulse 62/min, respiratory rate 14/min, blood pressure 156/96 HEENT: Unremarkable NECK: Swelling of submandibular salivary glands and serveral 1-2cm lymph nodes in anterior cervical region; otherwise unremarkable CHEST: Normal chest rise and fall; Fine, difuse bilateral inspiratory crackles, without wheezing; Normal resonance to percussion Physical Exam

Physical Exam, cont’d : 

Physical Exam, cont’d HEART: Regular rate with no murmur or gallop; S1 and S2 have normal intensity and splitting ABDOMEN: Soft, nontender; bowel sounds active; no masses or organomegaly noted; abdominal wall rises with inspiratory effort EXTREMITIES: No edema, clubbing or cyanosis; extremities warm with good capillary refill ROS:

Hospital Course : 

Hospital Course Presented to physician’s office Never admitted

ABG (on room air) : 

ABG (on room air) pH: 7.45 PaO2: 65 mm Hg PaCO2: 32 mm Hg HCO3-: 21 mEq/L P(A-a)O2: 44 mm Hg Chronic Respiratory Alkalosis with Mild Hypoxemia

Labs : 

Labs CBC -WBC 9.1 -RBC 4.3 -HGB 14.2 -HCT 41 Chemistry Na+ 142 K+ 4.1 Cl- 108 HCO3- 17 BUN 19 Creat 1.1 Ca 2.5 Phos 2.9 Uric Acid 6.9 Albumin 4.8 Protein 8.2

Slide 14: 


Chest Radiograph : 

Chest Radiograph Diffuse reticulonodular opacification Bilateral hilar enlargement Consistent with ILD

Respiratory Care Plan : 

Respiratory Care Plan Based on desaturation noted with moderate exercise, Mr. J begins receiving supplemental oxygen for home use PRN Sarcoidosis is one of the forms of ILD without a known cause, so therapy is aimed at supressing inflammation instead of preventing further exposure to an injuring agent

Medications : 

Medications Oxygen Prednisone, 20mg daily for 3 months, then 10 mg every other day for inflammation

Conclusion : 

Conclusion One year after the initial diagnosis of Sarcoidosis, Mr. J feels much better After taking Prednisone for 1 year, he shows much improvement from his initial chest radiograph He has less DOE and no longer requires supplmental oxygen Mr. J continues to have a restrictive defect on spirometry and a reduction in DLCO, but both of these parameters are improved.

Slide 20: 

PHYSICAL EXAM/HISTORY DOE, Non-productive cough, increased WOB, tachypnea, late inspiratory crackles, swollen lymph nodes, flu-like symptoms? YES NO -ABG -PFT -CXR -Consider other diseases and rule out -Increased P(A-a)O2 -Decreased Lung volumes: TLC, RV, FEV1=FVC -Abnormal DLCO -Ground-glass Appearance on CXR -Reticulonodular Cysts -Hilar lymphadeonpathy 1 2 3 4 See Box 2 Diagnosis of End-Stage ILD and Sarcoidosis YES Bronchoscopy With Transbronchial Biopsy Findings consistent With ILD? -Scarring of lung tissue, Inflammation, cysts. Laboratory Identification of sarcoidosis BEGIN TREATMENT Findings inconsistent with ILD? See Box 2 OR NO 5 6 7 Adapted from NHBLI Guidelines for the Diagnosis of Sarcoidosis

Works Cited : 

Works Cited Valeyre, D., Freynet, O., Bouvry, D., Anesi-Maesano, I., & Nunes, H. (2009). Epidemiology of interstitial lung diseases. Presse Med, 39(1), 53-59. Retrieved February 24, 2010, from the PubMed database. Wikins, Robert, Dexter, James & Gold, Phillip. (2007). Respiratory disease: a case study approach to patient care. F A Davis Co. Wu, J., & Rashcovsky-Schiff, K. (2004). Sarcoidosis. American Family Physician, 70(2), 312. Retrieved February 25, 2010, from http://www.aafp.org/afp/2004/0715/p312.html Sarcoidosis, lung function, tests, and diagnosis. (2010). National Heart, Lung and Blood Institute. Retrieved February 25, 2010, from http://www.nhlbi.nih.gov/health/dci/Diseases/sarc/sar_diagnosis.html

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