PMC5505914_01
A chest computed tomography scan showed a reticular shadow and ground-glass opacities with a mosaic-like appearance, predominantly in the lower lung.
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A computed tomography (CT) scan of the chest showed a reticular shadow and ground-glass opacities at the base of both lungs (Fig. 1).
Histological images. (A) The lesion was characterized by dense, interstitial fibrosis, which was largely maintained in the centriacinar, the subpleural region, and around the vessel (Hematoxylin and Eosin (H&E) staining, x25). (B) Partial dilation was observed from the bronchiole to the alveoli. There was almost no inflammatory cell infiltration around the bronchiole (H&E staining, x100).
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There was almost no inflammatory cell infiltration around the bronchiole (Fig. 2).
The clinical course. In the initial 5-year period of SSc-associated interstitial pneumonia, the patient's forced vital capacity (FVC) was moderately decreased, and the serum level of KL-6 remained high. After the diagnosis of SSc-RA overlap syndrome, treatment with prednisolone (PSL) (2.5-5 mg/day) and bucillamine was initiated and maintained. This resulted in a very slight increase in the patient's FVC and the normalization of the serum level of KL-6. The fibrosis in the lung progressed and formed a honeycomb lesion in the lower lung.
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The patient's radiological and respiratory function course during the approximately 16-year period from the initial diagnosis is shown in Figure 3, 4.
The radiological changes in the right basal lung during the 16-year observation period on high-resolution computed tomography. Peripheral subpleural reticulation was seen in 1999. After five years, the lesion extended, and dense opacity appeared in 2004. These lesions formed a honeycomb in 2010. Almost no changes were observed between 2010 and 2015.
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The patient's radiological and respiratory function course during the approximately 16-year period from the initial diagnosis is shown in Figure 3, 4.