eMedicine Specialties > Pulmonology > Interstitial Lung Diseases

Lymphocytic Interstitial Pneumonia: Follow-up

Author: Jussi J Saukkonen, MD, Assistant Professor, Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine, Boston University School of Medicine, Boston Medical Center
Contributor Information and Disclosures

Updated: Jan 17, 2008

Follow-up

Further Inpatient Care

  • Exclude pulmonary infections.
  • The presence of adequate oxygenation should be ascertained. Arrange for ambulatory supplementary oxygen if necessary.
  • If a transbronchial or open lung biopsy has been performed, postprocedure pneumothorax should be excluded or demonstrated to be small and stable by expiratory chest radiographs.

Further Outpatient Care

  • Periodically perform pulse oximetry at rest and with exercise.
  • Encourage consistent use of a standardized exercise course such as a long corridor or several flights of steps.
  • Obtain periodic chest radiographs and/or chest CT scan.
    • Assesses for improvement on therapy
    • Helps detect exacerbation of LIP or other pulmonary pathology, notably infections
    • Assesses for residual fibrosis
  • Determining if remaining respiratory compromise is related to pulmonary fibrosis or some other pulmonary pathology is critical.
  • Obtain clinical reevaluation, radiography, and/or chest CT scan if patient continues to require high-dose steroids.
  • A change in sputum may be the only sign of infection.

Inpatient & Outpatient Medications

  • After the first month of therapy and if disease activity allows it, gradually taper prednisone dosage. Use the lowest possible dose to suppress this chronic interstitial pneumonitis.
  • Monitor patient for signs of infection and other toxicities of corticosteroid or immunosuppressive therapy.

Transfer

  • Adequate gas exchange and a stable airway are required.
  • Appropriate medical records and copies of actual chest radiographs should be transferred.

Complications

  • Bronchiectasis has been associated with LIP. Whether this is due to LIP or the frequent bacterial infections these patients experience remains unclear.
  • Bronchitis and pneumonia commonly occur in these patients, with or without bronchiectasis or cystic changes.
  • Pulmonary fibrosis may be a long-term complication. Generally, it is indolent.
  • Respiratory failure has been reported, especially in the pediatric population.
  • Malignant transformation to lymphoma or association with lymphoid malignancy has been reported.

Prognosis

  • Clinical course is variable. The duration is 1 month to 11 years. It often is stable for months without treatment, and sometimes it improves spontaneously.
  • Symptoms often are recurrent and occasionally may lead to end-stage fibrosis or bronchiectasis.
  • Mortality data are inexact due to lack of reported follow-up and the anecdotal nature of reports.

Patient Education

  • Instructions to patients should include relating all potential toxicities of corticosteroids, including aseptic necrosis of the femoral head, infections, weight gain, hyperglycemia, and other adverse effects.
  • Instruct patients to seek medical attention for increased dyspnea or change in sputum.
 


More on Lymphocytic Interstitial Pneumonia

Overview: Lymphocytic Interstitial Pneumonia
Differential Diagnoses & Workup: Lymphocytic Interstitial Pneumonia
Treatment & Medication: Lymphocytic Interstitial Pneumonia
Follow-up: Lymphocytic Interstitial Pneumonia
Multimedia: Lymphocytic Interstitial Pneumonia
References
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References

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Further Reading

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Keywords

lymphocytic interstitial pneumonia, LIP, lymphoid interstitial pneumonitis, lymphoid pneumonitis, plasma cell interstitial pneumonitis, pulmonary interstitial infiltration, pseudolymphoma, autoimmune disorders, lymphoproliferative disorders, human immunodeficiency virus, HIV-related LIP, HIV-associated LIP, HIV, AIDS, Epstein-Barr virus, EBV, human T-cell leukemia virus, HTLV type 1, HIV type 1, rheumatoid arthritis, Hashimoto thyroiditis, myasthenia gravis, pernicious anemia, autoerythrocyte sensitization syndrome, chronic active hepatitis, common variable immunodeficiency, Sjögren syndrome, allogeneic bone marrow transplantation, lupus, lymphoma, B-cell CLL/lymphoma 6, BCL-6, zinc finger protein 51

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Contributor Information and Disclosures

Author

Jussi J Saukkonen, MD, Assistant Professor, Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine, Boston University School of Medicine, Boston Medical Center
Jussi J Saukkonen, MD is a member of the following medical societies: American Thoracic Society
Disclosure: Nothing to disclose.

Medical Editor

Stephen P Peters, MD, PhD, Professor, Department of Medicine, Wake Forest University
Stephen P Peters, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Daniel R Ouellette, MD, FCCP, Associate Professor of Medicine, Wayne State University School of Medicine; Consulting Staff, Pulmonary Disease and Critical Care Medicine Service, Henry Ford Health System
Daniel R Ouellette, MD, FCCP is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Boehringer Ingleheim Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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