eMedicine Specialties > Pulmonology > Interstitial Lung Diseases

Lymphocytic Interstitial Pneumonia: Treatment & Medication

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

Treatment

Medical Care

  • Asymptomatic and physiologically unaffected patients may not require treatment.
  • Symptomatic patients may require supportive care and immunosuppressives, chiefly corticosteroids. Occasionally, cytotoxic therapy has been used. No controlled treatment trials have been reported. Consider oxygen supplementation based on blood gas and/or exercise oximetry findings.
  • Antibiotics are used for associated pulmonary infections.
  • In pediatric patients with HIV, empiric treatment for LIP often is initiated based on the findings of subacute dyspnea, mild hypoxemia, and clubbing.
  • LIP has been reported to improve with the use of zidovudine alone. Instances of resolution with highly active antiretroviral therapy (HAART) have been reported.2
  • Bronchodilators may be used for associated wheezing.

Consultations

  • Consultation with a pulmonologist or thoracic surgeon may be necessary to obtain transbronchial biopsy or open lung biopsy, respectively.
  • In cases associated with HIV infection, consultation with a specialist familiar with HIV care is recommended.

Activity

  • Activity may be limited by exercise-induced oxygen desaturation.
  • Perform exercise oximetry to determine if supplementary oxygen is needed.

Medication

Medications should be used in patients who are symptomatic or physiologically compromised. Carefully weigh risks and benefits of immunosuppressive therapy in these patients.

HAART may result in improvement or resolution of LIP in some instances.2

One report describes dramatic improvement in LIP associated with common variable immunodeficiency treated with intravenous immunoglobulin without steroids.8

Corticosteroids

Used when patient is symptomatic and/or has physiologic compromise due to LIP. Risks of infection, osteoporosis, hyperglycemia, weight gain, dermatologic changes, and other potential toxicities should be weighed against any potential benefit.


Prednisone (Deltasone, Orasone, Sterapred)

For use as immunosuppressant in autoimmune disorders. By reversing increased capillary permeability and suppressing PMN activity, may decrease inflammation.
Doses on lower end of range are prescribed for at least 1 mo and tapered as tolerated. More than 50% respond. In some instances, chronic low-dose suppressive therapy required.

Adult

0.5-1 mg/kg/d PO

Pediatric

Administer as in adults

Coadministration with estrogens may decrease clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity, viral infection, peptic ulcer disease, hepatic dysfunction, connective tissue infections, fungal or tubercular skin infections, GI disease

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use

Alkylating agents

Are used when disease is refractory to corticosteroid therapy. Should be considered only in cases clearly unresponsive to corticosteroids used in high dosage. Should only be prescribed by physicians familiar with usage and toxicities. Generally prescribed for several weeks at a time; disease manifestations and complete blood count should be monitored.


Chlorambucil (Leukeran)

Reportedly given in pre-HIV era to patients with LIP refractory to corticosteroids. Anecdotal results, efficacy unclear.

Adult

0.1 mg/kg/d PO

Pediatric

Not established

Documented hypersensitivity; previous resistance to medication

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Causes infertility, is carcinogenic, and causes myelosuppression; lowest possible doses should be used; monitor CBC for neutropenia, lymphopenia, anemia, and thrombocytopenia; dosage is decreased or discontinued if counts fall below normal values; if rash develops, discontinue drug because it may cause severe Stevens-Johnson syndrome; potentially epileptogenic medication and should be administered with care to patients with history of seizure disorder, head trauma, or who receive other epileptogenic agents; monitor for GI bleeding or symptoms

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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  2. Ingiliz P, Appenrodt B, Gruenhage F, Vogel M, Tschampa H, Tasci S, et al. Lymphoid pneumonitis as an immune reconstitution inflammatory syndrome in a patient with CD4 cell recovery after HAART initiation. HIV Med. Sep 2006;7(6):411-4. [Medline].

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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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