65 years old lady with gradually pregressive dyspnea....HRCT s/o ILD, rest of the blood parameters are normal. She was started with IV methyl prednisolone followed by oral tablets along with N Acetyl cysteine...but, she is not responding with increasing dyspnea.....today we have added tab azathioprine. Any suggestion please...
Did you perform a BAL...are the inflammatory lab parameters elevated? You might consider adding intravenous antibiotics...
BAL is negative, Patient completed full course of broad spectrum i/v antibiotics and iv methylprednisolone. Her CRP is positive, ANA is negative, mild polymorphonuclear leukocytosis is there with elevated ESR. There is slight response to Azathioprine plus A acetyl cysteine therapy now.
Thanx Filiz, I am continuing with intravenous Imipenan and Moxifloxacin...
Azathioprin may reduces dependency on prednisolone, but, in my experience, has no added benefit in acute stage.
IV Cyclophosphamide has been suggested to help, although the evidence not strong. I would just like to add that non-invasive ventilation or mechanical ventilation with intubation are associated with almost certain death. If patients needed them, a palliative care approach should go hand in hand. Good luck.
I suggest to read this article: N Engl J Med 2012;366:1968-77. I know that it is frustrating but as MD, we should avoid to harm our patients. Best regards, G
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