Tobacco Cessation and Prevention: Student/Resident Case Report Poster - Tobacco Cessation and Prevention |

Remission of Nodular Pulmonary Langerhans-Cell Histiocytosis With Smoking Cessation Alone FREE TO VIEW

Chung Sang Tse, MD; Robert Vassallo, MD; Erin DeMartino, MD
Author and Funding Information

Mayo Clinic, Rochester, MN

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

Chest. 2016;150(4_S):1294A. doi:10.1016/j.chest.2016.08.1409
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SESSION TITLE: Student/Resident Case Report Poster - Tobacco Cessation and Prevention

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Pulmonary Langerhans-cell Histiocytosis (PLCH) is a diffuse lung disease usually occurring in cigarette smokers. While corticosteroids and chemotherapy may be indicated to treat nodular PLCH, their risk to benefit ratio and impact on disease progression are not well defined. We present two cases of nodular PLCH that resolved with smoking cessation alone, without the use of any pharmacological therapy.

CASE PRESENTATION: Case 1: A 35-year old Middle Eastern female active smoker with 38 pack-year history presented with six weeks of nonproductive cough. Chest x-ray and computed tomography (CT) demonstrated diffuse bilateral alveolar infiltrates, predominantly in the mid and upper lungs (Figures A and B). Pulmonary function testing (PFT) revealed reduced diffusing capacity for carbon monoxide (DLCO) at 11.1 mL/min/mmHg (47% predicted). Right upper lobe wedge resection confirmed PLCH. The patient committed to smoking cessation. Follow-up at 4, 9, and 41 months showed dramatic decrease in the number and size of nodules on chest x-ray and CT (Figures C and D). PFT returned to near-normal with DLCO 17.0-17.9 mL/min/mmHg (71-76% predicted). Case 2: A 34-year old Caucasian female active smoker with 20 pack-year history presented with two years of dyspnea on exertion and generalized body aches. Chest CT revealed bilateral nodular infiltrates predominantly in the upper and mid lungs (Figure E). Transbronchial biopsy of right upper lobe revealed PLCH. Magnetic resonance imaging of the head, x-ray skeletal survey, peripheral blood flow cytometry, and bone marrow biopsy were normal. Follow-up at 5 and 11 months demonstrated complete resolution of the nodules on chest CT (Figure F).

DISCUSSION: PLCH is a rare interstitial lung disease with isolated pulmonary involvement in > 85% of cases [1]. More than 90% of patients with PHLC have a history of smoking. In murine models, exposure to tobacco smoke was correlated with development of interstitial granulomatous inflammation similar to human PLCH; strikingly, cessation of tobacco smoke exposure reduced the density of pulmonary Langerhans’ cells to normal [2]. Pharmacotherapy with corticosteroids and cytotoxic agents like cladribine has been reported to induce disease remission in anecdotal reports and small case series [3]. While withholding pharmacotherapy for nodular PLCH raises concern of missing an opportunity to treat, the cases summarized herein suggest that smoking cessation alone may be sufficient for disease remission with objective lung function improvement.

CONCLUSIONS: Nodular PLCH is not necessarily an indication for pharmacotherapy: smoking cessation is a crucial initial intervention and can result in dramatic and sustained disease remission.

Reference #1: PMID 10877650

Reference #2: PMID 8532391

Reference #3: PMID 25899682

DISCLOSURE: The following authors have nothing to disclose: Chung Sang Tse, Robert Vassallo, Erin DeMartino

No Product/Research Disclosure Information




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