Pulmonary fibrosis with predominant CD8 lymphocytic alveolitis and anti-Jo-1 antibodies

Eur Respir J. 1997 Dec;10(12):2907-12. doi: 10.1183/09031936.97.10122907.

Abstract

Interstitial lung disease (ILD) is a complication of polymyositis (PM) and dermatomyositis (DM). It often manifests itself in association with myositis-specific antisynthetase autoantibodies, among which anti-Jo-1 antibodies are the most commonly encountered. In contrast, ILD associated with anti-Jo-1 antibodies without muscle involvement is rare and not well characterized. We report four patients presenting with ILD associated with anti-Jo-1 antibodies. Histological findings of transbronchial biopsies disclosed a pattern consistent with nonspecific interstitial pneumonitis, a CD8+ lymphocytosis was found in bronchoalveolar lavage. Only one of these patients developed an "antisynthetase syndrome" with PM, after nearly 2 yrs of severe ILD. The clinical conditions of all four cases showed stabilization or improvement when cyclosporine was added to their immunosuppressive treatment. These cases confirm that a CD8+ lymphocytic interstitial lung disease may be the first, and sole manifestation of autoimmune disease associated with anti-Jo-1 antibodies. Furthermore, they suggest that this form of interstitial lung disease apparently has a poor response to steroids and cytotoxic drugs, but may respond to moderate doses of cyclosporine and azathioprine in addition to low doses of steroids.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibodies, Antinuclear / analysis*
  • Autoantibodies / analysis
  • Azathioprine / therapeutic use
  • Biopsy, Needle
  • Bronchoalveolar Lavage Fluid / cytology
  • CD8-Positive T-Lymphocytes / immunology*
  • Cyclosporins / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lung Diseases, Interstitial / diagnosis
  • Lung Diseases, Interstitial / drug therapy
  • Lung Diseases, Interstitial / immunology*
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Pulmonary Fibrosis / diagnosis
  • Pulmonary Fibrosis / drug therapy
  • Pulmonary Fibrosis / immunology*
  • Steroids / therapeutic use

Substances

  • Antibodies, Antinuclear
  • Autoantibodies
  • Cyclosporins
  • Immunosuppressive Agents
  • Jo-1 antibody
  • Steroids
  • Azathioprine