Fig.1 Cutaneousfindingsandpathologicalfindingsofatransbronchiallungbiopsy(TBLB)andlichenifiedeczemaoftherightforearm.Thepatienthadlichenifiedeczemaonhisextremitiesandbodytrunk (1a:rightforearm,1b:leftthigh).Therewasinfiltrationoftheinflammatorylymphocytes,edemaandabrasioninthetype2alveolarepithelium ontblb(1c,hematoxylin-eosin, 100).Anincreasedamountofcollagenfiberandinfiltrationoflymphocyteswasobservedaroundthebloodvesselsinaskinbiopsyofthe rightforearm (1d,hematoxylin-eosinstain, 100).
Table1 Laboratorydataonadmissionandbronchoalveolarlavagefluid Hematology Serology Immunology BloodGasAnalysis(room air) WBC 10,800/μL CRP 7.17mg/dL IgG 2,760mg/dL ph 7.452 Neutro 84.0% Fe 96μg/dL IgA 626mg/dL PaO2 75.9mmHg Eosino 0.0% TIBC 135μg/dL IgM 162mg/dL PaCO2 36.3mmHg Baso 1.0% UIBC 231μg/dL C3 88μg/dL HCO3 25.8mmol/L Mono 6.0% vitaminb12 113pg/dL C4 22μg/dL AaDo2 28.7mmHg Lymph 9.0% folicacid 2.7mg/dL CH50 31.9U/mL RBC 154 10 4 /μl haptoglobin < 10mg/dL Immunecomplex 13.0mg/dL PulmonaryFunctionTest Hb 6.4g/dL DirectCoombstest Positive RF < 2.0IU/mL VC 1.90L MCV 9.0% IndirectCoombstestPositive Anti-CCP < 0.6U/mL %VC 61.1% MCHC 34.2% KL-6 536U/mL ANA < 40 FEV1.0 1.47L/sec Ht 18.7% SP-D 39.4μg/dL PR3-ANCA < 10EU/mL FEV1.0% 79.35% Reti 187 SP-A 24.3μg/dL MPO-ANCA < 10EU/mL %DLCO 49.2% Plt 34.3 10 9 /μl ft4 1.70ng/dL Anti-Jo-1 < 7.0U/mL TSH 1.40μU/mL Anti-SSA < 10.0U/mL Bronchoalveolarlavagefluid(rt.B 5a ) Biochemistry CEA 1.48ng/mL Anti-SSB < 15.0U/mL Recovery 79/150mL TP 7.1g/dL CA19-9 2.0U/mL Anti-SCL-70 < 1.0U/mL Totalcelcounts2.37 10 6 ml Alb 2.8g/dL Anti-centromere < 1.0U/mL Neutro 9.0% GOT 26IU/L Urinalysis Anti-dsDNA < 2.0IU/mL Eosino 6.0% GPT 9IU/L ph 5.5 Anti-Sm < 1.0U/mL Baso 0.0% LDH 313IU/L protein (- ) Anti-M2 < 5.0index Mono 3.0% γgtp 48IU/L sugar (- ) ACE 6.9IU/mL Lymph 66.0% ALP 263IU/L ketone (±) Lysozyme 7.2μg/dL Mφ 16.0% T-Bil 5.19mg/dL urobilinogen (±) CD4/CD8 1.92 D-Bil 3.7mg/dL bilirubin (+ ) others BUN 14.3mg/dL WBC 0-1/HPF β-d-glucan < 4.72pg/mL Cre 0.61mg/dL RBC 0-1/HPF Fig.2 Clinicalcourseofthepatientwithand
Fig.3 HighresolutionchestCT onadmission,andaftertreatment.volumelossinthelungandincreased densityinthesub-pleuralspacewereobservedonadmission(3a),whiledecreasedvolumeandregression ofthelesionwereobservedaftertreatment(3b).
Table2 Posteriorcasesautoimmunehemolyticanemia()associatedwithinterstitialpneumonia();review ofthe literature Author YearAge Sex Onset Diagnosisof Treatment Efect Outcome Mackey,etal. 1965 72 Female & Prednisolone60mg/day Mackey,etal. 1965 49 Female & Prednisolone45mg/day Scadding 1977 62 Male & Prednisone60mg/day & Scadding 1977 76 Male & unknown unknown Thomson 1981 72 Male Steroid Kanamori,etal. 1985 55 Male Methylprednisone1.0g,prednisolone60mg/day andcyclophosphamide100mg/day Yoshimine,etal.1985 71 Male & Prednisolone40mg/day & Otsuka,etal. 1985 69 Male & Prednisolone60mg/day & Wiliams,etal. 1985 52 Male & Prednisolone40mg/day & Senjyu,etal. 1990 58 Female U None Nochange Lortholary,etal.1990 66 Male & Prednisolone1mg/kg/day & Inoue,etal. 1994 70 Male Hydrocortisone600mg/day,methylprednisolone Noefect 1.0g/dayandprednisolone30mg/day Fujimori,etal. 2000 65 Female & BOOPs/o Prednisolone1mg/kg/day(50mg/day) & Iwami,etal. 2003 67 Female Steroidpulse,cyclophosphamidepluseandcyclo sporine200mg/day Nakadate,etal. 2006 72 Male & fns Prednisolone1mg/kg/day & Daeth Ourcase 71 Male & Prednisolone1mg/kg/day(60mg/day) AHIA & :fibrosingalveolitis,u:usualinterstitialpneumonia,boops/o:suspectofbronchiolitisobliteransorganizingpneumonia,fns: fibroticnonspecificinterstitialpneumonia α