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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Organizing pneumonia is a nonspecific pathologic pattern of response to lung damage&#46; It can be cryptogenic&#44; or secondary to different medical processes&#44; such as infections&#44; connective tissue diseases&#44; drug toxicity and radiotherapy&#44; among others&#46; The characteristic radiological pattern consists of the presence of patchy and bilateral pulmonary consolidations of peribronchial and subpleural distribution&#46; These lesions respond to treatment with corticoids&#44; migrate with or without treatment&#44; and tend to recur when treatment is decreased or withdrawn&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 50-year-old woman with a breast augmentation surgery &#40;prothesis 270cc de Mcghan&#41; in 1998 followed by a rupture of the left breast implant diagnosed in 2022&#46; Three months after the patient suffered from cough and fever&#46; In the chest X-ray &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41; lung opacities were seen in both bases&#46; The patient was treated with amoxicillin &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;8<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; Days after the cough worsened and she presented weight loss &#40;4<span class="elsevierStyleHsp" style=""></span>kg&#41; and chest pain&#46; A chest computed tomography &#40;CT&#41; was performed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; revealing many infiltrates with air bronchogram suggesting pneumonia in the left lower lobe&#46; Treatment with levofloxacin &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41; and prednisone &#40;0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41; was initiated with clinical improvement&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After 3 months the CT scan was repeated &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#44; showing new bilateral patchy consolidations&#44; mainly subpleural&#44; and partial resolution of those seen in the previous study&#46; A breast implant replacement was planned&#44; but the patient began again with cough and fever&#44; showing new right-lung infiltrates in the chest X-ray&#46; The study was completed with a blood test &#40;with negative autoantibodies&#41; and a bronchoscopy&#46; The bronchoalveolar lavage revealed an increased proportion of lymphocytes&#44; mostly T-cells&#44; and an inverted CD4&#47;CD8 ratio&#46; The transbronchial biopsy was described as pathologic pulmonary parenchyma affected with a pattern suggesting acute&#47;fibrinous pneumonia with discrete signs of organization &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; Adding up all the previous results&#44; the diagnosis of organizing pneumonia related to an autoimmune&#47;inflammatory syndrome induced by adjuvants &#40;ASIA&#41; arose in the context of breast implant rupture&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient initiated a longer and descending corticosteroid treatment &#40;prednisone&#44; 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41; for six months&#44; with improvement of the radiological consolidations&#46; During this period&#44; both breast implants were surgically removed &#40;showing the rupture of both prothesis&#41; with total bilateral capsulectomy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; The anatomical pathology studies showed that the capsule had a large cell foreign body-type lymph node reaction to a material that was consistent with breast implant material&#46; Finally&#44; the patient improved clinically and with subsequent disappearance of the pulmonary infiltrates &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The autoimmune&#47;inflammatory syndrome induced by adjuvants &#40;ASIA&#41; is a severe and rare condition&#46; Patients tend to have a genetic predisposition&#44; characterized by inappropriate immune response to adjuvants such as silicone &#40;used in breast implants&#41;&#44; with a higher incidence of reactions when ruptured&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> After revising the scientific literature&#44; we have not found any clinical cases that describe an association between ASIA and organizing pneumonia after breast implant&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The wide variety of symptoms &#40;arthralgias&#44; myalgias&#44; fatigue and even pulmonary or systemic affections&#41; makes the diagnosis more difficult&#44; and therefore&#44; the early approach to the disease is affected&#46; The diagnosis of ASIA syndrome is based on the diagnostic criteria proposed by Shoenfeld&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a> and subsequently by Alijotas-Reig&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> The main issue is their lack of specificity&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Our patient met the criteria in both scales&#46; Treating this syndrome requires taking away the trigger of the immune response and a correct immunosuppression&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The association between ASIA syndrome and organizing pneumonia is rare&#46; Understanding this syndrome and making an accurate diagnosis is crucial to develop new effective treatment and diagnostic strategies&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have not received any fees or funding for the development of the clinical case presented&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">All authors have made substantial contributions in each of the following aspects&#58; conception&#44; clinical case design and data acquisition&#44; drafting of the article and critical revision of the intellectual content&#44; and final approval of the presented version&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">Informed consent was obtained from the patient&#39;s relative for publication of the clinical data and images present in this manuscript&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">FV-&#193; has attended or participated in activities organized or financed by the pharmaceutical companies Almiral&#44; AstraZeneca&#44; Bial&#44; BoehringerIngelheim&#44; Chiesi&#44; GlaxoSmithKline&#44; Esteve&#44; Ferrer&#44; Menarini&#44; Novartis&#44; Mundipharma&#44; Orion&#44; Pfizer&#44; Teva and Zambon&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The rest of the authors declare no conflict of interest&#46;</p></span></span>"
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Journal Information
Vol. 60. Issue 10.
Pages 658-659 (October 2024)
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Vol. 60. Issue 10.
Pages 658-659 (October 2024)
Clinical Letter
Organizing Pneumonia Secondary to ASIA Syndrome
Visits
852
Pedro Piñero-Gutiérreza, Felipe Villar-Álvareza,b,c,
Corresponding author
fvillarleon@yahoo.es

Corresponding author.
, Paula Asensio-Mathewsd, David González-Peinadoe
a Pulmonology Department, IIS Fundación Jiménez Díaz, Madrid, Spain
b CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
c Universidad Autónoma of Madrid, Madrid, Spain
d Internal Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
e Department of Plastic and Reconstructive Surgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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