38,M,chronic dyspnea,cough,since 20yrs approximately.spo2 70%static. RS bil fine crepts, BP110/60mmhg. cxrays and lab attached.plz discuss possible provisional diagnosis.

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Pt is suffering from chr lung disease with leucocytosis over 18000 mainly lymphocytes 45% with anaemia hb being 8.6gm and xray of last month and fresh xray chest of this month are simillar with enhancing the changes of fibrosis suggestive of ild /copd as basal crepts and 4th gr clubbing is there. I shell treat him as copd with chest infection.

Thanks sir, But sir what about spo2 70%? Patient is on tiotropium+ formeterol,oral doxophylline,n acetyl cystiene,sildenafil for mod PAH. Are we dealing with COPD with something else?Plz guide.
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B/L diffuse cystic changes and destruction of Lung Parenchyma...Diffuse ground glassing...probably a distinct picture of ILD... Presence of Clubbing and Hypoxia with chronic cough supports the Diagnosis... Superimposed infection leading to leukocytosis... Do HRCT and give respiratory quinolones with oxygen therapy... Steroids with Anti fibrotic changes although its late

Thanks everyone for your valuable comments. Patient is a case of pulmonary Langerhans cell histiocytosis. (mentioned on discharge card) HPE report is. not available.

Sir for diagnosis LCH I think HRCT chest should be done
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Sir there is clubbing of nails + so we need to do 2D echo also, first treated as COPD with fluroquinols and clarithromycin.

Thanks,echo :mod PAH , patient is on sildenafil.
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

ILD.

Thanks sir
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IPF / Sarcoidosis / Chronic allergic Pneumonia / drugs induced pulmonary fibrosis etc

Thanks
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It is interstitial lung disease with cystic and fibrotic changes bilaterally in cxr along with superimposed infection and clubbing. One may go for cect chest to clinch the exact diagnosis. After defining a diagnosis, one may decide about the use of steroids vs perfenidione. Along with this, get ANA and ANCA levels done. Lft to rule out liver involvement.

Cystic disease of lung , lymphangiomyomatosis(LAM)

Thanks
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Bil diffuse reticulonidular infiltrations Leucocytosis ILD with Cor PULMONALE with bronchitis HRCT, ECHO ,ABG , suggested Antibiotics, nebulisers, bronchodilators ,O2 , diuretics, steroids

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