SEARCH

SEARCH BY CITATION

Keywords:

  • Acute interstitial pneumonia;
  • Hamman-Rich syndrome;
  • influenza;
  • pneumonia

Abstract

  1. Top of page
  2. Abstract
  3. Author contribution
  4. Disclosure
  5. References

Please cite this paper as: Fujita et al. (2012) Hamman-Rich syndrome revisited: How to avoid misdiagnosis. Influenza and Other Respiratory Viruses. DOI: 10.1111/j.1750-2659.2012.00353.x.

A 59-year-old man who had no underlying diseases except for obesity was referred to a private clinic with fever and sore throat. A rapid diagnostic test for influenza using the throat swab was performed and the result was negative. His symptoms did not improve, and he developed shortness of breath and inspiratory crackles in both lung fields, resulting in his transfer to a medium-sized hospital.

A rapid antigen test for influenza using the throat swab was negative again, and thus, the patient was considered to have acute interstitial pneumonia based on chest radiological findings (Figure 1), and bronchoalveolar lavage (BAL) as well as transbronchial lung biopsy (TBLB) was performed (Figure 2A, demonstrating a diffuse alveolar damage compatible with acute interstitial pneumonia). Using BAL fluid, PCR for pandemic H1N1 2009 was positive. In addition, a rapid diagnostic test for influenza A was also positive using BAL fluid (Figure 2B).

image

Figure 1.  Chest X-ray and chest CT findings of patient Both chest X-ray and chest CT demonstrate ground-glass and infiltrative shadow in both lung fields.

Download figure to PowerPoint

image

Figure 2.  Transbronchial lung biopsy (A) and rapid diagnostic test for influenza A Transbronchial biopsy specimen demonstrates the formation of a hyaline membrane which is compatible with acute interstitial pneumonia. Rapid diagnostic test for influenza A was positive using bronchoalveolar lavage fluid.

Download figure to PowerPoint

Two types of commercially available kits [QuickNavi-Flu (Denka Seiken Co., Ltd., Tokyo, Japan) and RapidTesta®-Flu Stick (Sekisui Medical Co. Ltd., Tokyo, Japan)] were used for the detection of influenza with this patient. It has been reported that the sensitivity of several rapid antigen test is not high enough for swine influenza virus detection.1–5 Several reports have demonstrated 40–69%,1 51%,2 38·3–53·3%3 and 44·2%5 sensitivities. In addition, it has also been suggested that by age group, clinical sensitivity was 85·7% in patients <2 years old, 60·3% in patients between 2 and 39 years old, and 33·3% in patients aged 40 and older.5 Therefore, clinicians should understand the obvious limitations (inadequate sensitivity) of many currently available rapid diagnostic tests for influenza viral infection.

If PCR for pandemic H1N1 2009 had not been performed, the patient would have been diagnosed with acute interstitial pneumonia: Hamman-Rich syndrome.6

Author contribution

  1. Top of page
  2. Abstract
  3. Author contribution
  4. Disclosure
  5. References

JF, MT, SH, FH and MT took care of this patient. HLC significantly helped to revise this letter.

Disclosure

  1. Top of page
  2. Abstract
  3. Author contribution
  4. Disclosure
  5. References

None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this study.

References

  1. Top of page
  2. Abstract
  3. Author contribution
  4. Disclosure
  5. References
  • 1
    Centers for Disease Control and Prevention. Evaluation of rapid influenza diagnostic tests for detection of novel influenza A (H1N1) Virus - United States, 2009. MMWR Morb Mortal Wkly Rep 2009; 58:826829.
  • 2
    Faix DJ, Sherman SS, Waterman SH. Rapid-test sensitivity for novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009; 361:728729.
  • 3
    Vasoo S, Stevens J, Singh K. Rapid antigen tests for diagnosis of pandemic (Swine) influenza A/H1N1. Clin Infect Dis 2009; 49:10901093.
  • 4
    Yang JH, Huang PY, Shie SS, Huang CG, Tsao KC, Huang CT. Diagnostic capacity of rapid influenza antigen test: reappraisal with experience from the 2009 H1N1 pandemic. J Microbiol Immunol Infect 2011; 2011 Dec 14. [Epub ahead of print].
  • 5
    Gao F, Loring C, Laviolette M, Bolton D, Daly ER, Bean C. Detection of 2009 pandemic influenza A(H1N1) virus Infection in different age groups by using rapid influenza diagnostic tests. Influenza Other Respi Viruses 2011; doi: 10.1111/j.1750-2659.2011.00313.x.
  • 6
    Hamman L, Rich AR. Acute diffuse interstitial fibrosis of the lungs. Bull Johns Hopkins Hosp 1944; 74:177212.