It was recommended that due to extensive emphysematous change superimposed pathology on a background childhood disease Selleck OTX015 be investigated. Biopsies from RML and RLL were taken. Microscopic examination form RML biopsy showed lung parenchyma with emphysematous change, patchy interstitial thickening due to inflammatory cell infiltration including lymphocytes, histiocytes and a few eosinophils and mild fibrosis. Also noted was paraseptal cyst without

any lining (bleb) and intraalveolar macrophages. Biopsy of RLL showed lung parenchyma with diffuse interstitial thickening due to inflammation and slight fibrosis, fresh hemorrhage in alveolar spaces, edema fluid and few cast like PAS positive material. No granuloma or malignancy was noted. Immunohistochemistry for HMB45, SMA was negative and for CD1a and S100 revealed few scattered immunoreactive cells in interstitial space. IHC for PC was negative. Sputum smear was negative for fungi. Laboratory tests showed normal renal function tests with leukocytosis (15.5 cells/MicroL) Selleck ATM Kinase Inhibitor and neutrophilia (Neut 80%) on CBC as well as anemia with Hgb 9.9 g/dl, MCV 76.3 fl and RDW of 17.5 and increased. ACE level was 63 IU/L. Other tests included SSA/RoIG 9.0 U/ml and SSB/LaIgG 6.0 U/mL

which were within normal limits. Tests from previous hospitalization were ESR 87 mm/h and RF negative. Also noted from previous admission were Parvovirus B19 negative, anti-ds DNA 0.83, CANCA Flucloronide 4.4 u/ml, PANCA 2.2 u/ml, ANA negative which were within normal limits. HIV (RTPCR) and HCV antibody titers were negative. Urinalysis was normal. Pathology report was emphysematous change with paraseptal bleb formation, unclassified interstitial lung disease consistent with NSIP due to HP or collagen vascular disease, or idiopathic NSIP. It was recommended that due to extensive emphysematous change superimposed pathology on a background

childhood disease be investigated. Diagnosis to be considered is NSIP due to collagen vascular disease and sniffing glue. The ability to diagnose NSIP (nonspecific interstitial pneumonia or a form of idiopathic interstitial lung disease) and other forms of chronic interstitial lung disease is considered significant as it not only agrees with different prognosis, but also may influence course of treatment. As a result, early diagnosis of interstitial lung disease and pulmonary referral is of significant prognostic value for the patient.2, 4 and 5 Authors of this case series also recently performed a study on 61 cases, 11 NSIP and 50 UIP, where pathologic diagnosis was reviewed and searched for noninvasive comparative diagnostic features. Clinical symptomatology was not distinguishing. The study focuses particularly on thin section CT scan findings with 1-mm collimation. HRCT of 36 patients (60%) showed honeycombing and 24 patients (40%) bilateral ground-glass and irregular reticular pattern. Lack of sub-pleural honeycombing was seen in UIP.