Viral Pneumonia Requiring Differentiation from Acute and Progressive Diffuse Interstitial Lung Diseases

Ishiguro, Takashi; Kobayashi, Yasuhito; Uozumi, Ryuji; Takata, Naomi; Takaku, Yotaro; Kagiyama, Naho; Kanauchi, Tetsu; Shimizu, Yoshihiko; Takayanagi, Noboru

Six of 13 patients with influenza-associated pneumonia received NIs (from the 5th to 23rd day from the onset of initial symptoms). In three of these 6 patients, both NIs and corticosteroids were started simultaneously, and these patients improved. In 4 of the 6 patients, NIs were started without corticosteroids (from the 5th, 8th, and 11th day after the onset of symptoms). NIs were effective in 2 of 3 patients. In the other patient, however, NI was administered from the 11th day after onset, but the patient showed early treatment failure and was switched to corticosteroid therapy from the 14th day, which was effective. In 7 patients who did not receive NIs, 6 received corticosteroid therapy (which was effective) from the 11th, 19th, 22nd, 23rd, 25th, and 47 th day, respectively, after the onset of symptoms. The pulmonary shadows of the two other patients who did not receive corticosteroids or NIs improved spontaneously during follow-up. Among the 40 patients suffering from viral pneumonia due to non-influenza viruses, corticosteroids with antibiotics were administered to 21 patients from a median of 15 (range, 6-45) days after the onset of symptoms. Two of these patients died. Corticosteroid therapy was effective in one of these patients; however, this patient experienced repeated episodes of aspiration pneumonia causing their condition to deteriorate until their death. The other patient showed early and late treatment failure with corticosteroid therapy, causing the progressive deterioration of the patient's condition until their death. The other 19 patients received antibiotics without corticosteroids and all survived.