Neumonía intersticial con características autoinmunes: reporte de caso

Andres Usma, Valentina Prieto, Darwin Zambrano, Christian Marin Giraldo, Angela Maria Giraldo Montoya, Lina Maria Saldarriaga Rivera

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Resumen

La neumonía intersticial con características autoinmunes por sus siglas en inglés, es una entidad en la que existe un compromiso pulmonar intersticial y hallazgos clínicos y paraclínicos que sugieren una enfermedad del tejido conectivo, pero sin lograr cumplir criterios diagnósticos para ninguna de estas. Con fines de investigación, se describieron en 2015 criterios para esta entidad, en los que se incluyen características de dominios clínicos, serológicos y morfológicos, con diversos patrones de compromiso pulmonar. En la actualidad hay un aumento en el interés de esta entidad, pues algunos autores sugieren que se pueda tratar de una patología autoinmune per se, cuyo órgano blanco principal sería el pulmón. Dado su reciente reconocimiento, son pocos los casos descritos en la literatura y por lo tanto con fines de contribuir a la mejor identificación de esa entidad, presentamos el caso de una paciente de 65 años con afectación pulmonar en quien después de descartar otras causas etiológicas se llegó al diagnóstico de neumonía intersticial con características autoinmunes al cumplir criterios de cada dominio requerido.

Palabras clave

enfermedades pulmonares; neumonía intersticial; fibrosis pulmonar idiopática, enfermedades del tejido conectivo.

Referencias

Fischer A, Antoniou KM, Brown KK, Cadranel J, Corte TJ, du Bois RM, et al. An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J. 2015;46(4):976-87. Disponible en: https://www.thoracic.org/statements/resources/interstitial-lung-disease/interstitial-pna-autoimmune.pdf

Mango R, Makol A, Crowson CS, Ryu JH, Matteson EL. Epidemiology of Interstitial Pneumonia with Autoimmune Features. [abstract]. Arthritis Rheumatol. 2017 [Acceso 24/04/2020];69(suppl 10). Disponible en: https://acrabstracts.org/abstract/epidemiology-of-interstitial-pneumonia-with-autoimmune-features/

Hervier B, Wallaert B, Hachulla E, Adoue D, Lauque D, Audrain M, et al. Clinical manifestations of anti-synthetase syndrome positive for anti-alanyl-tRNA synthetase (anti-PL12) antibodies: a retrospective study of 17 cases. Rheumatology (Oxford). 2010;49(5):972-6. https://doi.org/10.1093/rheumatology/kep455. Disponible en : https://academic.oup.com/rheumatology/article/49/5/972/1786211

Denton, C. P., & Khanna, D. (2017). Systemic sclerosis. Lancet (London, England), 390(10103), 1685–1699. https://doi.org/10.1016/S0140-6736(17)30933-9. Disponible en : https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30933-9.pdf

Robinson AB, Reed AM. Clinical features, pathogenesis and treatment of juvenile and adult dermatomyositis. Nat Rev Rheumatol. 2011;7(11):664-75. https://doi.org/10.1038/nrrheum.2011.139. Disponible en : https://www.nature.com/articles/nrrheum.2011.139

Chan EK, Damoiseaux J, Carballo OG, Conrad K, de Melo Cruvinel W, Francescantonio PL, et al. Report of the first international consensus on standardized nomenclature of antinuclear antibody HEp-2 cell patterns 2014-2015. Front Immunol. 2015;6:412. https://doi.org/10.3389/fimmu.2015.00412. Disponible en: https://www.frontiersin.org/articles/10.3389/fimmu.2015.00412/full

Didier K, Bolko L, Giusti D, Toquet S, Robbins A, Antonicelli F, et al. Autoantibodies associated with connective tissue diseases: what meaning for clinicians? Front Immunol. 2018;9:541. https://doi.org/10.3389/fimmu.2018.00541. Disponible en: https://www.frontiersin.org/articles/10.3389/fimmu.2018.00541/full

Gutsche M, Rosen GD, Swigris JJ. Connective tissue disease-associated interstitial lung disease: a review. Curr Respir Care Rep. 2012;1:224-32. https://doi.org/10.1007/s13665-012-0028-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23125954/

Kim EA, Lee KS, Johkoh T, Kim TS, Suh GY, Kwon OJ, et al. Interstitial lung diseases associated with collagen vascular diseases: radiologic and histopathologic findings. Radiographics. 2002;22 Spec No:S151-65. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK559094/.

Kelly BT, Moua T. Overlap of interstitial pneumonia with autoimmune features with undifferentiated connective tissue disease and contribution of UIP to mortality. Respirology. 2018;23(6):600-5. https://doi.org/10.1111/resp.13254. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29320807/

Oldham JM, Adegunsoye A, Valenzi E, Lee C, Witt L, Chen L, et al. Characterisation of patients with interstitial pneumonia with autoimmune features. Eur Respir J. 2016 Jun;47(6):1767-75. https://doi.org/10.1183/13993003.01565-2015. Disponible en: https://erj.ersjournals.com/content/47/6/1767.long

Strek ME, Oldham JM, Adegunsoye A, Vij R. A call for uniformity in implementing the IPAF (interstitial pneumonia with autoimmune features) criteria. Eur Respir J. 2016;48(6):1813-4. https://doi.org/10.1183/13993003.01841-2016. Disponible en: https://erj.ersjournals.com/content/48/6/1813.long

Bahmer T, Romagnoli M, Girelli F, Claussen M, Rabe K. The use of auto-antibody testing in the evaluation of interstitial lung disease (ILD)–A practical approach for the pulmonologist. Respir Med. 2016;113:80-92. https://doi.org/10.1016/j.rmed.2016.01.019. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26921132/

van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. Classification criteria for systemic sclerosis: An ACR-EULAR collaborative initiative. Arthritis Rheum. 2013;65(11):2737-47. https://doi.org/10.1136/annrheumdis-2013-204424. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930146/

Gianluca S, Sambataro G, Sambataro D, Torrisi SE, Vancheri A, Colaci M, et al. Clinical, serological and radiological features of a prospective cohort of Interstitial Pneumonia with Autoimmune Features (IPAF) patients. Respir Med. 2019;150:154-60. https://doi.org/10.1016/j.rmed.2019.03.011. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30961944/

Chartrand S, Swigris JJ, Stanchev L, Lee JS, Brown KK, Fischer A. Clinical features and natural history of interstitial pneumonia with autoimmune features: A single center experience. Respir Med. 2016;119:150-4. Disponible en: https://www.sciencedirect.com/science/article/pii/S0954611116302256.

Chung JH, Cox CW, Montner SM, Adegunsoye A, Oldham JM, Husain AN, et al. CT features of the usual interstitial pneumonia pattern: differentiating connective tissue disease –associated interstitial lung disease from idiopathic pulmonary fibrosis. AJR Am J Roentgenol. 2018;210(2):307-13. https://doi.org/10.2214/AJR.17.18384. Disponible en: https://www.ajronline.org/doi/10.2214/AJR.17.18384

Ahmad K, Barba T, Gamondes D, Ginoux M, Khouatra C, Spagnolo P, et al. Interstitial pneumonia with autoimmune features: clinical, radiologic and histological characteristics and outcome in a series of 57 patients. Respir Med. 2017;123:56-62. https://doi.org/10.1016/j.rmed.2016.10.017. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28137497/

Sambataro G, Sambataro D, Torrisi SE, Vancheri A, Pavone M, Rosso R, et al. State of the art in interstitial pneumonia with autoimmune features: A systematic review on retrospective studies and suggestions for further advances. Eur Respir Rev. 2018;2(27):148. https://doi.org/10.1183/16000617.0139-2017. Disponible en: https://err.ersjournals.com/content/27/148/170139.long

Chung JH, Montner SM, Adegunsoye A, Lee C, Oldham JM, Husain AN, et al. CT findings, radiologic-pathologic correlation, and imaging predictors of survival for patients with interstitial pneumonia with autoimmune features. AJR Am J Roentgenol. 2017 Jun;208(6):1229-36. https://doi.org/10.2214/AJR.16.17121. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28350485/

Fischer A, Brown KK, Du Bois RM, Frankel SK, Cosgrove GP, Fernandez-Perez ER, et al. Mycophenolate mofetil improves lung function in connective tissue disease-associated interstitial lung disease. J Rheumatol. 2013;40(5):640-6. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676865/

Swigris JJ, Olson AL, Fischer A, Lynch DA, Cosgrove GP, Frankel SK, et al. Mycophenolate mofetil is safe, well tolerated, and preserves lung function in patients with connective tissue disease-related interstitial lung disease. Chest. 2006;130(1):30-6. https://doi.org/10.1378/chest.130.1.30 Disponible en: https://pubmed.ncbi.nlm.nih.gov/16840379/

McCoy SS, Mukadam Z, Meyer KC, Sampene E, Kanne JP, Meyer CA, et al. Mycophenolate Mofetil May Improve Interstitial Pneumonia with Autoimmune Features [abstract]. Arthritis Rheumatol. 2017 [Acceso 24/04/2020];69(suppl 10). Disponible en: https://acrabstracts.org/abstract/mycophenolate-mofetil-may-improve-interstitial-pneumonia-with-autoimmune-features/

McCoy SS, Mukadam Z, Meyer KC, Kanne JP, Meyer CA, Martin MD, et al. Mycophenolate therapy in interstitial pneumonia with autoimmune features: A cohort study. Ther Clin Risk Manag. 2018; 14: 2171-81. https://doi.org/10.2147/TCRM.S173154. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219314/

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