PMC7076087_01
Chronological representation of the main clinical data of Case #1 (top) and Case #2 (bottom). AF, Atrial fibrillation; DIP, diffuse interstitial pneumonitis.
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PMC7076087_02_fmed-07-00077-g0001.jpg
F1
A 51-year-old man presented with dyspnea associated with atrial fibrillation and an acute coronary syndrome treated by angioplasty (Figure 1).
(A) ANA aspect of Case #1. IIF on Hep-2 (1/80) revealed presence of rare isolated cytoplasmic islets (1), homogenous staining (2), multiple nuclear dots pattern (3) and anti-Golgi apparatus pattern (4). (B) Radiographic imaging of Case #2. Thoracic computed tomography scan revealed bilateral interstitial lung disease with lower lung predominance, thickened alveolar septa, condensations, and traction bronchiectasis.
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F2
As the dyspnea persisted, a lung CT-scan showed a diffuse fibrosing interstitial pneumonitis (Figure 2).
PMC7076087_02
Chronological representation of the main clinical data of Case #1 (top) and Case #2 (bottom). AF, Atrial fibrillation; DIP, diffuse interstitial pneumonitis.
fmed-07-00077-g0001.jpg
PMC7076087_02_fmed-07-00077-g0001.jpg
F1
A 51-year-old man presented with dyspnea associated with atrial fibrillation and an acute coronary syndrome treated by angioplasty (Figure 1).
(A) ANA aspect of Case #1. IIF on Hep-2 (1/80) revealed presence of rare isolated cytoplasmic islets (1), homogenous staining (2), multiple nuclear dots pattern (3) and anti-Golgi apparatus pattern (4). (B) Radiographic imaging of Case #2. Thoracic computed tomography scan revealed bilateral interstitial lung disease with lower lung predominance, thickened alveolar septa, condensations, and traction bronchiectasis.
fmed-07-00077-g0002.jpg
PMC7076087_02_fmed-07-00077-g0002.jpg
F2
As the dyspnea persisted, a lung CT-scan showed a diffuse fibrosing interstitial pneumonitis (Figure 2).
Biological follow-up and treatment of Case #2. The full curve represents the regression of anti-MDA5 antibodies titers (expressed as relative intensity) and the dotted curve the evolution of serum ferritin level. Five plasma exchanges were performed (arrows), preceded and followed by cyclophosphamide infusions (depicted with stars). MDA5, melanoma differentiation-associated gene 5.
fmed-07-00077-g0003.jpg
PMC7076087_02_fmed-07-00077-g0003.jpg
F3
Since transplantation, the immunological monitoring has showed no reappearance of anti-MDA5 antibodies after 20 weeks of antirejection treatment and a slow normalization of ferritinemia, measured on DxI800 (Beckman-Coulter , France), was observed (Figure 3).