DIFFUSE INTERSTITIAL PULMONARY FIBROSIS CAMOUFLAGED BY HYPERMETABOLISM AND CARDIAC FAILURE: ANTEMORTEM DIAGNOSIS WITH BIOPSY AND CATHETERIZATION STUDIES

Abstract

A case of diffuse interstitial pulmonary fibrosis of the lungs of unknown causation is descr. This is the first instance in which a correct diagnosis was established antemortem by means of biopsy and catheterization studies. The patient demonstrated early in the illness a hypermetabolic state that was erroneously interpreted as hyperthyroidism. Later, he developed heart failure, the symptoms of which overshadowed the underlying pulmonary disorder. Finally, cortisone therapy was instituted after diagnosis was established. This is the first documented instance of diffuse, interstitial pulmonary fibrosis in which it was possible to study microscopically the effects of this drug before and after therapy. No real benefit was observed clinically or microscopically. It would seem that diffuse interstitial pulmonary fibrosis is not a specific disease entity but probably a syndrome produced by a variety of agents. It should be emphasized that although the disease primarily involves the lungs, the pulmonary features may be entirely obscured by the effect of the disease process on heart and circulation. The mechanism of heart failure in this disease is discussed.