A Possible Case of Desquamative Interstitial Pneumonia Without Performing a Surgical Lung Biopsy

Abstract

Case. A 58-year-old male smoker was admitted because of bilateral reticular shadows on a chest radiograph which were identified during a regular checkup. Chest computed tomography showed subpleural ground-glass attenuation predominantly in both lower lobes and slight mediastinal lymphadenopathy. After 3 months of smoking cessation, high levels of serum markers, such as KL-6, were observed to have decreased. The bronchoalveolar lavage fluid revealed an increase in the total number of cells, including elevated levels of eosinophils and neutrophils. Transbronchial lung biopsy (TBLB) specimens showed the accumulation of alveolar macrophages in the alveolae, hyperplastic alveolar pneumocytes, and slight thickening of the alveolar walls. An improvement in the chest computed tomography findings was seen without any treatment 5 months after the first visit. Therefore, a diagnosis of desquamative interstitial pneumonia (DIP) associated with smoking was made. Conclusion. In general, the diagnosis of DIP is normally based on the findings of surgical lung biopsy specimens; however, distinctive findings of bronchoalveolar lavage fluid and TBLB, and the clinical course may help to make such a diagnosis without the need to perform a surgical lung biopsy.