11th January 2024

Other features 

• Another common feature of ILD is persistent, non-productive cough. It is particularly common in conditions affecting airways, such as sarcoidosis, bronchiolitis obliterans, COP, eosinophilic pneumonia and HP. Productive cough is unusual.
• Haemoptysis can occur in vasculitis-related ILD, pulmonary venous hypertension and diffuse alveolar haemorrhage. First episode in a patient with a known ILD may sometimes point towards a malignancy – a well-recognised complication of ILD.
• Chest pain is uncommon; note that acute onset chest pain might point towards an ILD complication such as pneumothorax or pulmonary embolism (PE).
• Extrapulmonary symptoms can occur in connective tissue disorders and vasculitides. In particular, enquire about headaches, changes in vision or photosensitivity, skin rashes, dry mouth and eyes, joint pains or swelling, muscle aches, fatigue, night sweats and fevers. Absence of these symptoms does not rule out a systemic disorder, which may manifest as respiratory symptoms alone at the start. If present, however, they might provide a useful clue. In addition, clear documentation of negative findings at the baseline will help in patient assessment at later stages.
• Lofgren syndrome – specific acute presentation of systemic sarcoidosis, characterised by a triad of fever, erythema nodosum (see below) and bilateral hilar lymphadenopathy on chest X-ray. This is more common in Caucasians. It is usually self-limiting and carries a good prognosis – 80% of cases will resolve spontaneously over 1-2 years.

Image Source: Wikimedia Commons (2010). ENlegs, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:ENlegs.JPG#/media/File:ENlegs.JPG. (Accessed: 3 January 2023).