PMC4840426_01
(a) Chest X-ray picture on admission. Reduction of lung volume and reticular shadows were observed bilaterally. (b and c) Chest computed tomography showed extensive ground-glass opacity including irregular reticular opacity in both lung fields. The distribution of interstitial shadows was peribronchovascular and basal dominant.
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A chest radiograph showed reduction of bilateral lung-volume and reticular shadows in all lung fields (Fig. 1a). The distribution of interstitial shadows was peribronchovascular and basal dominant (Fig. 1b and c).
Pathological findings of biopsy specimens. (a) Atypical and multinucleated regenerating alveolar epithelial cells are found. Eosinophils, lymphocytes and plasma cells have infiltrated the lungs (Hematoxylin and Eosin staining). (b) Dense air space aggregates are present and stained blue, which indicated the subacute phase of the disease (Alcian-blue-PAS staining).
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Biopsy specimens of the lung showed atypical and multinucleated regenerative alveolar epithelial cells, and infiltration of eosinophils, lymphocytes and plasma cells was observed (Fig. 2a). Interstitial fibrosis was seen both in the alveoli and around the thickened alveolar walls (Fig. 2b).
Clinical course of the patient. After cessation of vildagliptin and initiation of glucocorticoid therapy, the patient's respiratory symptoms and GGO findings on chest CT gradually improved. Serum KL-6 and IgE levels also improved.
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Vildagliptin was discontinued on the day that the patient was admitted (day 20) and glucocorticoid therapy was initiated on day 27 (Fig. 3).