Management of Myositis-Related Interstitial Lung Disease

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Management of Myositis-Related Interstitial Lung Disease Julie Morisset, MD, Cheilonda Johnson, MD, Eric Rich, MD, Harold R. Collard, MD, FCCP, Joyce S. Lee, MD CHEST Volume 150, Issue 5, Pages 1118-1128 (November 2016) DOI: 10.1016/j.chest.2016.04.007 Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 1 Radiologic appearance of myositis-related interstitial lung disease (ILD). A, Nonspecific interstitial pneumonia (NSIP) pattern. High-resolution CT (HRCT) scan demonstrating the characteristic radiographic appearance of NSIP with peripheral ground glass and irregular reticulation with subpleural sparing. B, Organizing pneumonia (OP). HRCT scan demonstrating the characteristic radiographic appearance of OP with rounded regions of peribronchovascular and subpleural consolidation. C, Combination of NSIP and OP pattern. HRCT scan demonstrating peripheral ground glass and peripheral consolidation. CHEST 2016 150, 1118-1128DOI: (10.1016/j.chest.2016.04.007) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 2 Histopathologic appearance of myositis-related interstitial lung disease (ILD). A, Fibrosing and cellular nonspecific interstitial pneumonia (NSIP) pattern. Lung biopsy specimen demonstrates uniform thickening of the alveolar septa by fibrosis and chronic inflammation. B, Organizing pneumonia (OP). A lung biopsy specimen demonstrating polypoid rounded plugs of granulation tissue are noted within alveolar spaces. CHEST 2016 150, 1118-1128DOI: (10.1016/j.chest.2016.04.007) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 3 Proposed algorithm for the treatment of myositis-related interstitial lung disease (ILD). AZA = azathioprine; CsA = cyclosporine A; CYC = cyclophosphamide; HRCT = high-resolution CT; IVIG = IV immunoglobulin; MMF = mycophenolate mofetil; PFTs = pulmonary function tests. CHEST 2016 150, 1118-1128DOI: (10.1016/j.chest.2016.04.007) Copyright © 2016 American College of Chest Physicians Terms and Conditions