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

Joseph G Parambil1, Jeffrey L Myers, Jay H Ryu

  • 1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.

Chest
|August 11, 2006
PubMed

Insights

Diffuse alveolar damage (DAD) in connective tissue disease (CTD) patients can complicate existing interstitial lung disease (ILD) or present as a new CTD diagnosis. Outcomes are worse for those with prior ILD.

Area of Science:

  • Pulmonary Medicine
  • Rheumatology
  • Pathology

Background:

  • Diffuse alveolar damage (DAD) is a frequent finding in surgical lung biopsies, with diverse potential etiologies.
  • Connective tissue diseases (CTDs) are known to be associated with various pulmonary complications, including interstitial lung disease (ILD).

Purpose of the Study:

  • To investigate the association between connective tissue disease (CTD) and diffuse alveolar damage (DAD) diagnosed via surgical lung biopsy.
  • To explore the clinical implications and outcomes of DAD in patients with CTDs.

Main Methods:

  • Retrospective analysis of nine consecutive patients with CTD and DAD diagnosed on surgical lung biopsy.
  • Review of patient demographics, underlying CTDs, clinical presentation, imaging findings (CT chest), and treatment outcomes.

Main Results:

  • The study cohort included patients with rheumatoid arthritis, polymyositis, systemic sclerosis, and mixed CTD.
  • DAD occurred either as a complication of pre-existing CTD-related ILD (78% of cases) or as an initial manifestation leading to CTD diagnosis (22% of cases).
  • Hospital survival was 44%, with a poorer prognosis observed in patients with pre-existing chronic ILD compared to those without.

Conclusions:

  • Diffuse alveolar damage (DAD) is a significant complication in patients with connective tissue disease (CTD)-related interstitial lung disease (ILD).
  • DAD can also serve as an early presenting sign of an undiagnosed CTD.
  • The presence of pre-existing chronic ILD in CTD patients with DAD is associated with a worse clinical outcome.
Abstract

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