Pulmonary Manifestations of Systemic Disease: Systemic Disease |

Lymphocytic Interstitial Pneumonia in a Patient With Secondary Sjogren’s Syndrome FREE TO VIEW

Rahim Wooley, MD; Lauren Blackwell, MD; Anne Sutherland, MD
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Rutgers-New Jersey Medical School, Montclair, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A471. doi:10.1016/j.chest.2016.02.490
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SESSION TITLE: Systemic Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Interstitial lung disease is common in patients with primary Sjogren’s syndrome, but not in secondary disease. We present a case of a patient presenting with shortness of breath and a long history of keratoconjunctivitis sicca and Raynaud’s phenomenon.

CASE PRESENTATION: This is a 58 year old woman with a history of DM, HTN, and anemia presenting with dyspnea on exertion for the past month associated with fatigue, productive cough, light-headedness, and palpitations. One week prior to presentation, she was treated for pneumonia and was informed that she had lung nodules. She never smoked tobacco, emigrated from Jamaica in 1979, and completed treatment for a positive skin tuberculin test in 1999. Review of systems revealed Raynaud’s phenomenon, dry eyes, and dry mouth. Bronchoalveolar lavage showed a lymphocytic predominance (46%). Inflammatory work up revealed elevated ESR and CRP, a positive ANA with speckled pattern, and elevated anti-SS-A and anti-SS-B. CT-guided lung biopsy was consistent with lymphocytic interstitial pneumonia. The patient was diagnosed with SLE and secondary Sjogren’s syndrome. She was treated with systemic corticosteroids and cyclophosphamide.

DISCUSSION: Secondary Sjogren’s syndrome occurs in association with other connective tissue diseases, most commonly rheumatoid arthritis and SLE. Interstitial lung disease is common in patients with primary Sjogren’s syndrome, but tends to occur less frequently and is more severe in those with secondary Sjogren’s (1). Nonspecific interstitial pneumonia is the most common histologic subtype of ILD associated with primary Sjogren’s syndrome, with lymphocytic interstitial pneumonia occurring in 17% of patients in one series (2). To date, there has been one other published case report of lymphocytic interstitial pneumonia in a patient with SLE and secondary Sjogren’s syndrome (3).

CONCLUSIONS: Lymphocytic interstitial pneumonia is rare in association with secondary Sjogren’s syndrome.

Reference #1: Vitali C, Tavoni A, Viegi G, Begliomini E, Agnesi A, Bombardieri S. Lung involvement in Sjögren’s syndrome: a comparison between patients with primary and with secondary syndrome. Ann Rheum Dis. 1985 Jul;44(7):455-61.

Reference #2: Kreider M, Highland K. Pulmonary involvement in Sjögren syndrome. Semin Respir Crit Care Med. 2014 Apr;35(2):255-64.

Reference #3: Garcia D, Young L. Lymphocytic interstitial pneumonia as a manifestation of SLE and secondary Sjogren’s syndrome. BMJ Case Rep. 2013 Aug 2;2013.

DISCLOSURE: The following authors have nothing to disclose: Rahim Wooley, Lauren Blackwell, Anne Sutherland

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