Abstract
BACKGROUND—Pulmonary interstitial fibrosis in children is a disease of unknown aetiology, usually associated with a poor prognosis. METHODS—In this case series we describe 11 children presenting over a 10 year period, managed conservatively and associated with a good prognosis. RESULTS—In six, symptoms were present from birth and 10 had symptoms at or before 3 months. Diagnosis was made using chest computed tomography and percutaneous lung biopsy. All patients were treated with oral prednisolone. In five no steroid response was noted. One patient responded to hydroxychloroquine. Home oxygen was required in five patients. At follow up all patients are alive at a median age of 6 years (range 1 to 12 years). The two recently diagnosed children have significant symptoms, seven have dyspnoea on exercise, and two are symptom free. CONCLUSION—The good prognosis seen in these patients is different to previous case reports, indicating a greater than 50% mortality.
Full Text
The Full Text of this article is available as a PDF (120.6 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Barnes S. E., Godfrey S., Millward-Sadler G. H., Roberton N. R. Desquamative fibrosing alveolitis unresponsive to steroid or cytotoxic therapy. Arch Dis Child. 1975 Apr;50(4):324–327. doi: 10.1136/adc.50.4.324. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bitterman P. B., Rennard S. I., Keogh B. A., Wewers M. D., Adelberg S., Crystal R. G. Familial idiopathic pulmonary fibrosis. Evidence of lung inflammation in unaffected family members. N Engl J Med. 1986 May 22;314(21):1343–1347. doi: 10.1056/NEJM198605223142103. [DOI] [PubMed] [Google Scholar]
- Bokulic R. E., Hilman B. C. Interstitial lung disease in children. Pediatr Clin North Am. 1994 Jun;41(3):543–567. doi: 10.1016/s0031-3955(16)38769-7. [DOI] [PubMed] [Google Scholar]
- Carrington C. B., Gaensler E. A., Coutu R. E., FitzGerald M. X., Gupta R. G. Natural history and treated course of usual and desquamative interstitial pneumonia. N Engl J Med. 1978 Apr 13;298(15):801–809. doi: 10.1056/NEJM197804132981501. [DOI] [PubMed] [Google Scholar]
- Chadelat K., Baculard A., Grimfeld A., Tournier G., Boule M., Boccon-Gibod L., Clement A. Pulmonary sarcoidosis in children: serial evaluation of bronchoalveolar lavage cells during corticosteroid treatment. Pediatr Pulmonol. 1993 Jul;16(1):41–47. doi: 10.1002/ppul.1950160109. [DOI] [PubMed] [Google Scholar]
- Chan-Yeung M., Müller N. L. Cryptogenic fibrosing alveolitis. Lancet. 1997 Aug 30;350(9078):651–656. doi: 10.1016/S0140-6736(97)06303-4. [DOI] [PubMed] [Google Scholar]
- Coultas D. B., Zumwalt R. E., Black W. C., Sobonya R. E. The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med. 1994 Oct;150(4):967–972. doi: 10.1164/ajrccm.150.4.7921471. [DOI] [PubMed] [Google Scholar]
- DeRemee R. A., Harrison E. G., Jr, Andersen H. A. The concept of classic interstitial pneumonitis-fibrosis (CIP-F) as a clinicopathologic syndrome. Chest. 1972 Mar;61(3):213–220. doi: 10.1378/chest.61.3.213. [DOI] [PubMed] [Google Scholar]
- Egan J. J., Woodcock A. A. Does the treatment of cryptogenic fibrosing alveolitis influence prognosis? Respir Med. 1996 Mar;90(3):127–130. doi: 10.1016/s0954-6111(96)90153-5. [DOI] [PubMed] [Google Scholar]
- Fan L. L., Langston C. Chronic interstitial lung disease in children. Pediatr Pulmonol. 1993 Sep;16(3):184–196. doi: 10.1002/ppul.1950160309. [DOI] [PubMed] [Google Scholar]
- Fan L. L., Mullen A. L., Brugman S. M., Inscore S. C., Parks D. P., White C. W. Clinical spectrum of chronic interstitial lung disease in children. J Pediatr. 1992 Dec;121(6):867–872. doi: 10.1016/s0022-3476(05)80330-0. [DOI] [PubMed] [Google Scholar]
- Garner P., Panpanich R., Logan S. Is routine growth monitoring effective? A systematic review of trials. Arch Dis Child. 2000 Mar;82(3):197–201. doi: 10.1136/adc.82.3.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kelley J. Cytokines of the lung. Am Rev Respir Dis. 1990 Mar;141(3):765–788. doi: 10.1164/ajrccm/141.3.765. [DOI] [PubMed] [Google Scholar]
- Kerem E., Bentur L., England S., Reisman J., O'Brodovich H., Bryan A. C., Levison H. Sequential pulmonary function measurements during treatment of infantile chronic interstitial pneumonitis. J Pediatr. 1990 Jan;116(1):61–67. doi: 10.1016/s0022-3476(05)81646-4. [DOI] [PubMed] [Google Scholar]
- LIEBOW A. A., STEER A., BILLINGSLEY J. G. DESQUAMATIVE INTERSTITIAL PNEUMONIA. Am J Med. 1965 Sep;39:369–404. doi: 10.1016/0002-9343(65)90206-8. [DOI] [PubMed] [Google Scholar]
- Lacronique J. G., Rennard S. I., Bitterman P. B., Ozaki T., Crystal R. G. Alveolar macrophages in idiopathic pulmonary fibrosis have glucocorticoid receptors, but glucocorticoid therapy does not suppress alveolar macrophage release of fibronectin and alveolar macrophage derived growth factor. Am Rev Respir Dis. 1984 Sep;130(3):450–456. doi: 10.1164/arrd.1984.130.3.450. [DOI] [PubMed] [Google Scholar]
- Lawson G. R. Controversy: Sedation of children for magnetic resonance imaging. Arch Dis Child. 2000 Feb;82(2):150–153. doi: 10.1136/adc.82.2.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Noble S. E., Leyland K., Findlay C. A., Clark C. E., Redfern J., Mackenzie J. M., Girdwood R. W., Donaldson M. D. School based screening for hypothyroidism in Down's syndrome by dried blood spot TSH measurement. Arch Dis Child. 2000 Jan;82(1):27–31. doi: 10.1136/adc.82.1.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Osika E., Muller M. H., Boccon-Gibod L., Fauroux B., Sardet A., Grosskopf C., Couvreur J., Tournier G., Clement A. Idiopathic pulmonary fibrosis in infants. Pediatr Pulmonol. 1997 Jan;23(1):49–54. doi: 10.1002/(sici)1099-0496(199701)23:1<49::aid-ppul6>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
- Owen L., Ellis M., Shield J. Deliberate sulphonylurea poisoning mimicking hyperinsulinaemia of infancy. Arch Dis Child. 2000 May;82(5):392–393. doi: 10.1136/adc.82.5.392. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Raynor P., Rudolf M. C. Anthropometric indices of failure to thrive. Arch Dis Child. 2000 May;82(5):364–365. doi: 10.1136/adc.82.5.364. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rudd R. M., Haslam P. L., Turner-Warwick M. Cryptogenic fibrosing alveolitis. Relationships of pulmonary physiology and bronchoalveolar lavage to response to treatment and prognosis. Am Rev Respir Dis. 1981 Jul;124(1):1–8. doi: 10.1164/arrd.1981.124.1.1. [DOI] [PubMed] [Google Scholar]
- Scott J., Johnston I., Britton J. What causes cryptogenic fibrosing alveolitis? A case-control study of environmental exposure to dust. BMJ. 1990 Nov 3;301(6759):1015–1017. doi: 10.1136/bmj.301.6759.1015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sharief N., Crawford O. F., Dinwiddie R. Fibrosing alveolitis and desquamative interstitial pneumonitis. Pediatr Pulmonol. 1994 Jun;17(6):359–365. doi: 10.1002/ppul.1950170604. [DOI] [PubMed] [Google Scholar]
- Smyth R. L., Carty H., Thomas H., van Velzen D., Heaf D. Diagnosis of interstitial lung disease by a percutaneous lung biopsy sample. Arch Dis Child. 1994 Feb;70(2):143–144. doi: 10.1136/adc.70.2.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Speight N., Wynne J. Controversy: Is the Children Act failing severely abused and neglected children? Arch Dis Child. 2000 Mar;82(3):192–196. doi: 10.1136/adc.82.3.192. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Steinkamp G., Müller K. M., Schirg E., von der Hardt H. Fibrosing alveolitis in childhood. A long-term follow-up. Acta Paediatr Scand. 1990 Aug-Sep;79(8-9):823–831. doi: 10.1111/j.1651-2227.1990.tb11561.x. [DOI] [PubMed] [Google Scholar]
- Stillwell P. C., Norris D. G., O'Connell E. J., Rosenow E. C., 3rd, Weiland L. H., Harrison E. G., Jr Desquamative interstitial pneumonitis in children. Chest. 1980 Feb;77(2):165–171. doi: 10.1378/chest.77.2.165. [DOI] [PubMed] [Google Scholar]
- Turner-Warwick M., Burrows B., Johnson A. Cryptogenic fibrosing alveolitis: response to corticosteroid treatment and its effect on survival. Thorax. 1980 Aug;35(8):593–599. doi: 10.1136/thx.35.8.593. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Venn G., Goldstraw P. Open lung biopsy. Br J Hosp Med. 1988 Apr;39(4):272-3, 276. [PubMed] [Google Scholar]
- Winterbauer R. H., Hammar S. P., Hallman K. O., Hays J. E., Pardee N. E., Morgan E. H., Allen J. D., Moores K. D., Bush W., Walker J. H. Diffuse interstitial pneumonitis. Clinicopathologic correlations in 20 patients treated with prednisone/azathioprine. Am J Med. 1978 Oct;65(4):661–672. doi: 10.1016/0002-9343(78)90855-0. [DOI] [PubMed] [Google Scholar]
- Zar H. J., Tannenbaum E., Apolles P., Roux P., Hanslo D., Hussey G. Sputum induction for the diagnosis of pulmonary tuberculosis in infants and young children in an urban setting in South Africa. Arch Dis Child. 2000 Apr;82(4):305–308. doi: 10.1136/adc.82.4.305. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zar H. J., Weinberg E. G., Binns H. J., Gallie F., Mann M. D. Lung deposition of aerosol--a comparison of different spacers. Arch Dis Child. 2000 Jun;82(6):495–498. doi: 10.1136/adc.82.6.495. [DOI] [PMC free article] [PubMed] [Google Scholar]