TY - JOUR T1 - Relapse of respiratory insufficiency one year after organising pneumonia JF - European Respiratory Journal JO - Eur Respir J SP - 1062 LP - 1065 DO - 10.1183/09031936.04.00000204 VL - 24 IS - 6 AU - J-M. Naccache AU - M. Kambouchner AU - F. Girard AU - M. Antoine AU - A. Parrot AU - J. Piquet AU - M. Brauner AU - D. Valeyre Y1 - 2004/12/01 UR - http://erj.ersjournals.com/content/24/6/1062.abstract N2 - A 66-yr-old nonsmoker female presented in June 1998 with a 3-week history of progressive dyspnoea. Her past medical history was noteworthy for idiopathic bilateral uveitis without sequelae between 1978 and 1993, hypercholesterolaemia and angina pectoris. Her medication included fluvastatin, which started in June 1997 (60 mg·day−1), trinitrin patch and acetylsalicylic acid. She had no particular work-related or environmental dust exposure. Examination of the chest revealed bilateral basal crackles. There was no digital clubbing or extrapulmonary signs. At admission, chest radiograph and thoracic computed tomography (CT) scan (fig. 1a⇓) revealed patchy consolidations, predominantly involving the bilateral lower lobes.Fig. 1.— Computed tomography (CT) scans of 1-mm thickness at lung window. a) CT scan revealed irregularly marginated patchy alveolar consolidations with an air bronchogram. The lesions were bilateral and predominantly involved the lower lobes. b) After 1 yr, the consolidations disappeared almost completely. CT scan revealed some linear opacities of irregular thickness. c) CT scan from September 1999. d) CT scan revealed the same lesions with some improvement in May 2003. Arterial blood gas analysis under supplemental oxygen (6 L·min−1) revealed a partial pressure of oxygen of 8.3 kPa (62 mmHg), a partial pressure of carbon dioxide of 4.3 kPa (32 mmHg) and a pH of 7.46. As a result of rapidly progressive respiratory failure, she was admitted to the intensive care unit. Bronchoalveolar lavage (BAL) analysis showed a 140×106 cells·L−1 increased lymphocyte rate (38%), low CD4/CD8 ratio (0.18), increased neutrophil rate (17%), 44% of macrophages and 1% of eosinophils. Transbronchial lung biopsy, including 20 alveoli, revealed typical lesions of organising pneumonia (fig. 2a⇓). Minor salivary gland biopsy specimens found no sign of Sjögren's syndrome. Antinuclear antibodies were positive at a titre of 1:50 of speckled pattern; anti-JO1 antibodies were positive. Neither clinical nor biological signs of muscular involvement were found. Fluvastatin was stopped.Fig. 2.— a) Transbronchial biopsy … ER -