22 October 2019 : Case report
Challenging differential diagnosis, Rare diseaseHiroshi Kobayashi1ABCDEFG*, Yoshiro Otsuki2ABDE, Misako Yamaguchi3BCDF, Kento Ko3BCD, Shogo Mizuno4ABD, Masuo Ujita5BCE, Riuko Ohashi6ABF, Takao Sato7ABE, Hideo Sato8BCDE, Toshimitsu Suzuki1DEG
Am J Case Rep 2019; 20:1551-1557
BACKGROUND: Pulmonary capillary hemangiomatosis (PCH) and pulmonary veno-occlusive disease (PVOD) are rare diseases that share clinical, X-ray, and histological features. Most patients have poor prognosis due to severe respiratory impairment. Recently, EIF2AK4 mutations were found in some patients with PCH and PVOD, but the role of this mutation is still unknown. We report an autopsy case of PCH and discuss a mechanism of respiratory dysfunction based on an electron microscopy study.
CASE REPORT: The patient was a Japanese man in his sixties. He suffered from acute exacerbation of dyspnea during treatment of COPD. Respiratory function testing revealed DLCO’ 32.1% and DLCO’/VA 23.6%. Echocardiography demonstrated findings consistent with pulmonary hypertension. A CT scan showed mild emphysema and small ground-glass opacity in the lungs. However, we could not find the exact cause of his respiratory failure and he died 28 days after admission. At autopsy, the histology showed multilayering capillary proliferation within the alveolar walls. Electron microscopy examination revealed prominent widening of the air–blood barrier, scarce fusion of the epithelial and capillary basement membranes, and frequent narrowing of the capillary lumen.
CONCLUSIONS: We reported an autopsy case with PCH with no histological findings of PVOD. Whether PCH and PVOD are 2 different histological patterns of the same disease remains to be verified. The changes in the air–blood barrier detected by electron microscopy may explain the respiratory impairment and pulmonary arterial hypertension.
Keywords: Blood-Air Barrier, Hypertension, Pulmonary, Microscopy, Energy-Filtering Transmission Electron, Pulmonary Veno-Occlusive Disease, Aged, Asians, Autopsy, Fatal Outcome, Hemangioma, Capillary, Microscopy, Electron, Middle Aged, Respiratory Function Tests, Respiratory Insufficiency
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