Pulmonary Manifestations of Systemic Disease: Pulmonary Manifestations of Systemic Disease |

An Asymptomatic Ankylosing Spondylitis Case With Chronic Lung Damage and Mixed Pulmonary Infection FREE TO VIEW

Jing Bao, MD; Bingbing Lu, MD; Zhaolong Cao, MD; Rongbao Zhang, MD; Yanliang Ma, MD; Zhang Moqin, MD; Zhancheng Gao, MD
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Peking University People's Hospital, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A460. doi:10.1016/j.chest.2016.02.479
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SESSION TITLE: Pulmonary Manifestations of Systemic Disease

SESSION TYPE: Case Report Slide

PRESENTED ON: Saturday, April 16, 2016 at 09:45 AM - 11:15 AM

INTRODUCTION: Ankylosing spondylitis is a chronic inflammatory condition that usually affects young men. It is common to see series of related pulmonary manifestationseven in early stage. But the diagnosis of ankylosing spondylitis is often delayed for asymptomatic features.

CASE PRESENTATION: A 34 years old male patient was admitted to our hospitial with chief complaint of “cough for 2 years, recurrent purulent sputum for 1 year, hemoptysis for 4 months, recurred for 1week”. He denied lower back pain. 16 years ago he was diagnosed as lung tuberculosis and received anti-tuberculosis drugs for 8 months. his right hip ached intermittently, the symptom alleviated gradually without any treatment several months later. The patient experienced 3 episodes of acute pneumothorax. Physical examination showed extremly emaciation. multiple surgical scars on chest wall. Double lung percussion showed hyperresonance, auscultation showed roughbreath sounds without wheezes or crackles. Spinal forward bend, extend, rotation seemed slightly stiff, lateral normal. The thoracic mobility test: (2 cm); Other examiniations almost normal. Auxiliary examination:T - SPOT. TB negative; (bronchial secretions) tests: tuberculosis bacili, common bacteria cultivation, fungi, mycobacterium tuberculosis PCR negative, no fungus spore and mycelium; G test 31.18 pg/ml (negative); GM test 1.85 (positive) rheumatoid factor (RF): 20.7 IU/ml write, c-reactive protein (CRP): 102.00 mg/L write; The HLA-B27: +. Chest CT:double lung multiple pulmonary emphysema, bronchiectasis, multiple infection, left upper lobe cystic shadow Pericardial a small amount of effusion, bilateral partial pleura hypertrophy. Sacroiliac joint CT: bilateral sacroiliac arthritis and osteoarthritis stiffness. Lumbar positive side: lumbar bone not seen obvious abnormity. Diagnosis:Ankylosing spondylitis associated pulmonary damage mixed with infection (aspergillus and bacteria).

DISCUSSION: This case is an asymptomatic ankylosing arthritis patient long affected by pulmonary damage, including “tuberculosis” diagnosing and treatment, pneumothorax, bronchiectasis, cavity, ground glass shadow and succeeded mixed pulmonary infection. Early diagnosis and intervention is really valuable, this case is an example of delayed diagnosis and treatment, which developed to damaged lung structure and repeated lung infections which led to treatment contradictions.

CONCLUSIONS: Ankylosing spondylitis associated pulmonary damage maybe the only obvious and most important clinical clue for AS diagnosis and should be learned and carefully disdinguished especially in young men with upper lung lesions.

Reference #1: El Maghraoui A, Dehhaoui M. Prevalence and characteristics of lung involvement on high resolution computed tomography in patients with ankylosing spondylitis: a systematic review. Pulmonary Medicine. 2012, doi:10.1155/2012/965956

DISCLOSURE: The following authors have nothing to disclose: Jing Bao, Bingbing Lu, Zhaolong Cao, Rongbao Zhang, yanliang Ma, Zhang Moqin, Zhancheng Gao

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