Atypical Sjögrenʼs Syndrome Initially Presenting as Lymphocytic Interstitial Pneumonitis followed by Immune Thrombocytopenia
Background. Sjögrenʼs syndrome is an autoimmune disease characterized primarily by decreased exocrine gland function leading to eye and mouth dryness. Extraglandular manifestations occur less frequently. Case Report. A 74-year-old man with hypertension was admitted with productive cough and fever. O...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-01-01
|
| Series: | Case Reports in Rheumatology |
| Online Access: | http://dx.doi.org/10.1155/2021/6681590 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832547631455272960 |
|---|---|
| author | Maham Mehmood Abhishrut Jog Masooma Niazi Arlene Tieng Giovanni Franchin |
| author_facet | Maham Mehmood Abhishrut Jog Masooma Niazi Arlene Tieng Giovanni Franchin |
| author_sort | Maham Mehmood |
| collection | DOAJ |
| description | Background. Sjögrenʼs syndrome is an autoimmune disease characterized primarily by decreased exocrine gland function leading to eye and mouth dryness. Extraglandular manifestations occur less frequently. Case Report. A 74-year-old man with hypertension was admitted with productive cough and fever. On physical examination, he had bilateral lower lung decreased breath sounds. A chest radiograph showed bibasilar patchy infiltrate. Laboratory studies revealed hemoglobin of 11.9 g/dL, white blood cell count of 16,000/uL, and platelet count of 250,000/uL. Empiric antibiotic therapy was begun for suspected community acquired pneumonia, and then he was discharged home. However, his cough recurred. Chest computed tomography demonstrated adenopathy throughout the mediastinum and multiple ill-defined patchy groundglass opacities with a lower lobe prominence. He underwent a transbronchial biopsy to rule out malignancy; however, it showed lymphocytic interstitial pneumonitis. Antinuclear antibody was 1 : 80 homogeneous, and anti-SSA antibody was 6.3 AI (normal <1.0 AI). The patient was treated with prednisone 20 mg/day with marked improvement in his symptoms. Repeat chest computed tomography showed decreased groundglass opacities and decreased mediastinal lymph nodes. After more than a year, he was readmitted due to petechiae on his buccal mucosa and a platelet count of 2000/μL. The patient was started on prednisone 80 mg/d and intravenous immunoglobulin 80 g/d for 2 consecutive days. The platelet count eventually increased to 244,000/μL. Conclusion. We report a rare presentation of Sjogrenʼs syndrome manifesting as acute lymphocytic interstitial pneumonitis and followed by immune thrombocytopenia. Both extraglandular manifestations responded well to corticosteroid therapy. |
| format | Article |
| id | doaj-art-482b4b6220b04851be176aa5170d7dba |
| institution | Kabale University |
| issn | 2090-6889 2090-6897 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Rheumatology |
| spelling | doaj-art-482b4b6220b04851be176aa5170d7dba2025-02-03T06:43:58ZengWileyCase Reports in Rheumatology2090-68892090-68972021-01-01202110.1155/2021/66815906681590Atypical Sjögrenʼs Syndrome Initially Presenting as Lymphocytic Interstitial Pneumonitis followed by Immune ThrombocytopeniaMaham Mehmood0Abhishrut Jog1Masooma Niazi2Arlene Tieng3Giovanni Franchin4Department of Internal Medicine, BronxCare Health System, Bronx, NY, USADepartment of Internal Medicine, BronxCare Health System, Bronx, NY, USADepartment of Pathology, BronxCare Health System, Bronx, NY, USADepartment of Internal Medicine, BronxCare Health System, Bronx, NY, USADepartment of Internal Medicine, BronxCare Health System, Bronx, NY, USABackground. Sjögrenʼs syndrome is an autoimmune disease characterized primarily by decreased exocrine gland function leading to eye and mouth dryness. Extraglandular manifestations occur less frequently. Case Report. A 74-year-old man with hypertension was admitted with productive cough and fever. On physical examination, he had bilateral lower lung decreased breath sounds. A chest radiograph showed bibasilar patchy infiltrate. Laboratory studies revealed hemoglobin of 11.9 g/dL, white blood cell count of 16,000/uL, and platelet count of 250,000/uL. Empiric antibiotic therapy was begun for suspected community acquired pneumonia, and then he was discharged home. However, his cough recurred. Chest computed tomography demonstrated adenopathy throughout the mediastinum and multiple ill-defined patchy groundglass opacities with a lower lobe prominence. He underwent a transbronchial biopsy to rule out malignancy; however, it showed lymphocytic interstitial pneumonitis. Antinuclear antibody was 1 : 80 homogeneous, and anti-SSA antibody was 6.3 AI (normal <1.0 AI). The patient was treated with prednisone 20 mg/day with marked improvement in his symptoms. Repeat chest computed tomography showed decreased groundglass opacities and decreased mediastinal lymph nodes. After more than a year, he was readmitted due to petechiae on his buccal mucosa and a platelet count of 2000/μL. The patient was started on prednisone 80 mg/d and intravenous immunoglobulin 80 g/d for 2 consecutive days. The platelet count eventually increased to 244,000/μL. Conclusion. We report a rare presentation of Sjogrenʼs syndrome manifesting as acute lymphocytic interstitial pneumonitis and followed by immune thrombocytopenia. Both extraglandular manifestations responded well to corticosteroid therapy.http://dx.doi.org/10.1155/2021/6681590 |
| spellingShingle | Maham Mehmood Abhishrut Jog Masooma Niazi Arlene Tieng Giovanni Franchin Atypical Sjögrenʼs Syndrome Initially Presenting as Lymphocytic Interstitial Pneumonitis followed by Immune Thrombocytopenia Case Reports in Rheumatology |
| title | Atypical Sjögrenʼs Syndrome Initially Presenting as Lymphocytic Interstitial Pneumonitis followed by Immune Thrombocytopenia |
| title_full | Atypical Sjögrenʼs Syndrome Initially Presenting as Lymphocytic Interstitial Pneumonitis followed by Immune Thrombocytopenia |
| title_fullStr | Atypical Sjögrenʼs Syndrome Initially Presenting as Lymphocytic Interstitial Pneumonitis followed by Immune Thrombocytopenia |
| title_full_unstemmed | Atypical Sjögrenʼs Syndrome Initially Presenting as Lymphocytic Interstitial Pneumonitis followed by Immune Thrombocytopenia |
| title_short | Atypical Sjögrenʼs Syndrome Initially Presenting as Lymphocytic Interstitial Pneumonitis followed by Immune Thrombocytopenia |
| title_sort | atypical sjogren s syndrome initially presenting as lymphocytic interstitial pneumonitis followed by immune thrombocytopenia |
| url | http://dx.doi.org/10.1155/2021/6681590 |
| work_keys_str_mv | AT mahammehmood atypicalsjogrenʼssyndromeinitiallypresentingaslymphocyticinterstitialpneumonitisfollowedbyimmunethrombocytopenia AT abhishrutjog atypicalsjogrenʼssyndromeinitiallypresentingaslymphocyticinterstitialpneumonitisfollowedbyimmunethrombocytopenia AT masoomaniazi atypicalsjogrenʼssyndromeinitiallypresentingaslymphocyticinterstitialpneumonitisfollowedbyimmunethrombocytopenia AT arlenetieng atypicalsjogrenʼssyndromeinitiallypresentingaslymphocyticinterstitialpneumonitisfollowedbyimmunethrombocytopenia AT giovannifranchin atypicalsjogrenʼssyndromeinitiallypresentingaslymphocyticinterstitialpneumonitisfollowedbyimmunethrombocytopenia |