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However, in this latter case, ILD exacerbation recurred when oral prednisolone was administered at the dose of 20 mg, and chest CT revealed a DAD pattern.
Moreover, in one anti-MDA-5 antibody-positive case with subpleural GGO (as shown in Fig. 2a), autopsy revealed diffuse alveolar septal thickening due to organizing fibrosis, airspace organization, and hyaline membranes, suggesting a diffuse alveolar damage (DAD) pattern.
Although no reports have evaluated the histopathological findings of treatment-naïve CADM-ILD with anti-MDA-5 antibody, the pathological findings of autopsied lung in CADM-ILD with anti-MDA-5 antibody mostly revealed a DAD pattern [ 26– 28].
Chest CT findings at the onset of toxicity in the 2 cases of PEM-related pulmonary toxicity in the IIPs group (a single patient each in the UIP and non-UIP IIPs groups) showed a diffuse alveolar damage (DAD) pattern.
The DAD pattern consists of new diffuse and bilateral ground glass opacity (GGO) together with a reticular shadow in the non-segmental predominance of lung opacity with new traction bronchiectasis [ 15, 16].
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Of those who died, eight were determined as having CT-non-DAD-like pattern on CT scan and the remaining patient was determined as having CT-DAD-like pattern.
The mortality rate for ILD among patients who were deemed to have CT-DAD-like pattern was higher than that seen among patients who were deemed as having CT-non-DAD-like pattern (65.1% vs 32.2%, respectively).
In the 63 patients with CT-DAD-like pattern, six (9.5%) patients recovered, 12 (19.1%) patients improved, three (4.8%) patients did not recover, one (1.6%) patient had residual ILD sequelae, and 41 (65.1%) patients died.
In the 220 patients with a CT-non-DAD-like pattern, 37 (16.8%) patients recovered, 95 (43.2%) patients improved, 13 (5.9%) patients did not recover, one (0.5%) patient had residual ILD sequelae, 71 (32.3%) patients died, and three (1.4%) patients had unknown outcomes.
However, histology revealed hyaline membranes in the vicinity of AFOP-patterns, thus classifying it as DAD with focal patterns of AFOP.
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