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Weekly Chest CasesArchive of Old Cases

Case No : 1105 Date 2018-12-31

  • Courtesy of Eun Jin Chae, MD. / Asan Medical Center, University of Ulsan College of Medicine
  • Age/Sex 42 / F
  • Chief ComplaintCough, systemic lupus erythematosus
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Lymphocytic interstitial pneumonia in a patient with SLE
Radiologic Findings
Fig 1. Diffuse ill-defined increased opacity in both mid to lower lung zones on chest radiograph.
Fig 2-6. CT images show diffuse and bilateral ground glass opacity lesions and multiple thin walled and well-demarcated cysts in both lungs.
Brief Review
The lymphocytic interstitial pneumonia (LIP) is a rare disease characterized by diffuse infiltration of lymphocytes and plasma cells within the lung parenchyma. In the adult population, it most commonly affects middle age women, frequently occurring in patients with Sjögren syndrome, autoimmune thyroid disease, myasthenia gravis, and pernicious anemia. One-third of adult cases of LIP is associated with Sjögren Syndrome.
The thorax is more frequently involved in SLE than in any other collagen vascular disease. The majority of patients with SLE have thoracic involvement at some time during their clinical course. Pleural and pericardial disease are the most common thoracic manifestations. Infectious pneumonia, lupus pneumonitis, alveolar hemorrhage, chronic interstitial pneumonitis/fibrosis, pulmonary hypertension, thromboembolism, bronchiolitis obliterans, bronchiolitis obliterans organizing pneumonia, and diaphragmatic muscle dysfunction have been described. Although there has been prior association between SLE and pulmonary lymphoma, LIP is distinctly uncommon in SLE. The majority of patients with SLE will develop thoracic involvement at some point in their disease. This is most frequently pleural and pericardial disease. LIP, although commonly associated with autoimmune disease, is rarely seen in patients with SLE.
Reflecting diffuse infiltration of lymphocytes and plasma cells, HRCT usually reveals thickening of perilymphatic interstitium, ground-glass opacity, and poorly defined centrilobular nodules. Furthermore, multiple variable sized thin-walled cystic airspaces are common finding, and should be good differential point from other idiopathic interstitial pneumonias. Other findings include lymph node enlargement (in about 50% of cases) and bronchiectasis.
Definite diagnosis can be made with lung biopsy. Although there is no standard treatment for LIP, steroid therapy is commonly used and other immunosuppressive drugs may be combined.
Prognosis is variable, and can be grave. Therefore, keen radiologic suspicion and early diagnosis is crucial.
References
1. T Johkoh, N Muller, H Pickford, et al. Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients. Radiology 1999;212:567.
2. Filipek S, Thompson ME, Wang PL, et al. J Thorac Imaging. 2004 Jul;19(3):200-3. Lymphocytic interstitial pneumonitis in a patient with systemic lupus erythematosus: radiographic and high-resolution CT findings.
Keywords
Lung, Interstitial pneumonia, Systemic lupus erythematosus,

No. of Applicants : 94

▶ Correct Answer : 63/94,  67.0%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - staten island univ hosp , United States JOSEPH LOWRY
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - , Japan MASAFUMI KAIUME
  • - radiologist, aditya imaging centre , India VIVEK PATEL
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - National cancer center hospital east , Japan SHIOTO ODA
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - Lille , France BENOIST CAPON
  • - , Turkey BARAN GUNDOGUS
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Prince Sattam ibn Abdulaziz University hospital , Saudi Arabia ELBAGIR MOHAMED NASSIR
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Qatif Central Hospital , Saudi Arabia HANI MAKKY ALSALAM
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - HHS , Canada S LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Wuhan Union Hospital , China NANCHUAN JIANG
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Inha University Hospital , Korea (South) PARK JUYONG
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - , United States MAANSI P
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - , Japan NAOMI YUASA
  • - , Greece NIKOLAOS VOUGIOUKLIS
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - Tashkent Medical Academy , Uzbekistan Rustam Azimovich Fayzullaev
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - , Pakistan KHALID SHAKEEL BABAR
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 12/94,  12.8%
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - , United Kingdom SAMSON K
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Pavilh李 , Brazil THIAGO KRIEGER BENTO DA SILVA
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