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Neumonía criptogénica estacional con colestasis bioquímico: una nueva entidad clínica
M A Spiteri1, P Klenerman, M N Sheppard
1Royal Brompton Hospital, London, UK.
Lancet (London, England)
|August 1, 1992
Resumen
Este estudio identifica un síndrome de neumonía organizadora estacional con anomalías de las enzimas hepáticas. Los síntomas se repiten anualmente, lo que sugiere un desencadenante ambiental inhalado, y responden a la terapia con esteroides.
Área de la Ciencia:
- Pulmonología Pulmonología.
- Hepatología Hepatología.
- Medicina Ambiental La medicina ambiental es una medicina que tiene que ver con el ambiente.
Sus antecedentes:
- La neumonía criptogénica organizadora (COP) se caracteriza por hallazgos clínicos, radiológicos e histológicos específicos.
- La recurrencia estacional de la COP no ha sido previamente bien documentada.
- La colestasis intrahepática asociada en la COP es rara.
Objetivo del estudio:
- Para describir un síndrome estacional distinto de neumonía organizada con colestasis intrahepática concurrente.
- Investigar las características clínicas, la progresión y la respuesta al tratamiento en pacientes con este trastorno estacional.
- Explorar posibles desencadenantes ambientales para esta condición respiratoria y hepática recurrente.
Principales métodos:
- Serie de casos retrospectiva de 12 pacientes con reaparición estacional documentada de la neumonía organizadora.
- Evaluación clínica que incluye diarios de síntomas, radiografía de tórax, tomografía computarizada (TC) y pruebas de función pulmonar.
- Examen histopatológico de muestras de biopsia pulmonar.
- Evaluación bioquímica de la función hepática y exclusión de agentes infecciosos.
Principales resultados:
- Los 12 pacientes presentaron una recurrencia anual de los síntomas (finales de febrero-principios de mayo) y una resolución (junio-enero) durante 3-11 años.
- Las imágenes de tórax revelaron consolidación bilateral; las biopsias pulmonares mostraron tejido de granulación intraalveolar y obstrucción de las vías respiratorias.
- La función pulmonar fue predominantemente restrictiva; todos los pacientes tenían enzimas hepáticas elevadas que sugieren colestasis intrahepática.
- El trabajo infeccioso y la detección viral fueron negativos; todos los pacientes respondieron rápidamente a los esteroides orales.
Conclusiones:
- Se identifica un síndrome estacional distinto de neumonía organizada con colestasis intrahepática.
- La periodicidad anual sugiere fuertemente un agente ambiental inhalado específico para ciertas estaciones.
- Se necesita más investigación para identificar el agente etiológico específico responsable de esta condición recurrente.
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