ILD

38 years old female afaf ala Elam complaining of severe shortness of breath and cough with yellow sputum 10 days ago. Condition started with dyspnea on exertion and cough with small amount of sputum 20 years ago and taking non specific treatment for several time but condition was gradually progressive till 5 years ago. Then with severe dyspnea even at rest, recurrent chest infection, high fever and frequent large amount of sputum, she admitted to Kasr Al Ainy Hospital diagnosed as ILD and she was under medication and oxygen therapy from 5 years ago, but 10 days ago from today February 26 2015 complaining of severe dyspnea at all events, always on sitting with head upward frequent large amount of yellow sputum and chest pain. on physical examination, clubbing of fingers shown on the picture,

 patient on oxygen therapy, crepitation, wheezing, right ankle edema and palpitation.

Patient past history: T.B positive with 9 month anti-TB medication while she was 15 year old and cured with medication. After 3 years later, she had dyspnea and cough as mentioned above and now under oxygen therapy, prednisolone, antibiotic (azathioprine), acetyl cysteine, calcium and folic acid, also with Viagra, the patient under investigation. To gain knowledge of this case read below article.

How does ILD present above symptoms?
what is ILD?
What is the relation between symptoms and ILD?
how to suspect the case of ILD?

ILD: Interstitial Lung Disease means disease in the interstitium of the lung. Interstitium include parenchymal tissue, epithelium, capillary endothelium, basement membrane, perivascular and....vascular lymphatic tissue. In this case, parenchymal tissue is replaced by fibrous tissue through scarring and damaged due to unknown etiology. But suspected cause in this case are TB, asbestos;patient was working in the  cloths factory and bacterial infections due to yellow sputum. Fibrosis of tissues leads to decrease gas exchange as a result dyspnea on exertion, cough and remaining symptoms secondary to infection most probably. Remember, doctors are the brilliant detective for the diseases through taking patient history.
How to suspect or become a detective?
Always from the patient symptoms, every disease have their own symptoms and also every disease have their confirmatory test to confirm the disease, thus you need to memorize these with understanding.
In this case, require the HRCT and  sputum culture with sensitivity test if not respond to treatment.
Chest X-ray may show fine reticular shadow and honeycombing in advanced case of this case.

Treatment: Treat the underlying cause, cause may be autoimmune that is why corticosteroids is the choices but it can not prevent once fibrosis developed. In severe  case, lung transplantation is the best option. Treatment is the same as patient taking medication.