Lymphocytic interstitial pneumonitis (LIP) is a disease of unknown etiology, which usually occurs after the age of 50, and is manifested by chronic cough and dyspnea. It is a rare but relatively specific feature of Sjögren’s syndrome

Kuštra, Nikolina

Ledenko, Robert

Padjen, Ivan

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CR57Lymphocytic interstitial pneumonitis (LIP) as an extraglandular manifestation of primary Sjögren's syndrome: a case reportNikolina Kuštraa, Robert Ledenkoa, Ivan Padjenba University of Zagreb, School of Medicineb Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre ZagrebDOI: https://doi.org/10.26800/LV-144-supl2-CR57 Nikolina Kuštra 0000-0002-9131-224X, Robert Ledenko 0000-0002-5105-6202, Ivan Padjen 0000-0002-9249-9325Keywords: glucocorticoids, rheumatoid factor, Sjögren’s syndromeINTRODUCTION/OBJECTIVES: Lymphocytic interstitial pneumonitis (LIP) is a disease of unknown etiology, which usually occurs after the age of 50, and is manifested by chron-ic cough and dyspnea. It is a rare but relatively specific feature of Sjögren’s syndrome.CASE PRESENTATION: A 61-year-old male was hospital-ized due to fever, cough and increased inflammatory markers.His chest X-ray and chest CT scan were consistent with in-terstitial lung disease. CT scan revealed bilateral basal cystic lesions (up to 3 cm in diameter) and thickening of the inter-lobular septa. Moreover, he complained of dry mouth. His sicca syndrome was confirmed by a low saliva flow rate as well as positive Schirmer test. Laboratory workup revealed an increased erythrocyte sedimentation rate (out of proportion to the C-reactive protein levels), as well as increased rheumatoid factor and positive antinuclear antibodies (double-stranded DNA, SS-A and SS-B). Bone marrow aspiration revealed no sign of hematological disease. Bronchoalveolar lavage cytol-ogy was consistent with LIP. The patient was diagnosed with LIP in the context of Sjögren’s syndrome and was commenced on prednisone 30 mg with gradual dose tapering. He was also started on hydroxychloroquine and subsequently also on azathioprine as a steroid-sparing agent. The treatment led to normalization of inflammatory markers and improvement of symptoms. A follow-up chest CT scan revealed residual cysts in the lung parenchyma.CONCLUSION: We presented a patient with Sjoegren’s syn-drome and LIP with a favorable clinical course. Glucocor-ticoids are the first line of treatment, however an additional immunosuppressive agent may be added to facilitate disease control and steroid tapering.CR58Manifestations of tuberculosis that we rarely think aboutMaja Kopušara, Tin Karakašb, Lea Kalajžićb, Sandra Kneževića, Klara Poldan Skorupc a Faculty of Medicine, University of Rijeka, Croatiab School of Medicine, University of Zagreb, Croatiac Department of Emergency Medicine, Clinical Hospital Centre Rijeka, Rijeka, CroatiaDOI: https://doi.org/10.26800/LV-144-supl2-CR58 Maša Kopušar 0000-0001-5910-9826, Tin Karakaš 0000-0001-6504-0669, Lea Kalajžić 0000-0002-4824-021X, Sandra Knežević 0000-0003-4863-1963, Klara Poldan Skorup 0000-0003-0063-7282Keywords: Cerebrovascular insult, Pulmonary embo-lism, TuberculosisINTRODUCTION/OBJECTIVES: Tuberculosis is a multi-system infectious disease caused by Mycobacterium Tu-berculosis. Tuberculosis mostly affects lungs but it can spread in the form of extrapulmonary tuberculosis. Around 4.3% of patients experience ischemic stroke and 1.5-3.4% of them ex-perience pulmonary embolism.CASE PRESENTATION: A 41-year-old male patient, was ad-mitted to the Emergency Department due to plegic left arm and depressed left corner of the lip. Vital signs were normal, besides low blood oxygen saturation (SpO2). Blood pressure was 134/108 mmHg, heart rate 106 bmp, body temperature 36.8 °C, respiratory rate 22 per minute and SpO2 was 77%. During the physical examination, the left arm was sinking into antigravitational position. Auscultatory, diffuse bilateral crep-itations were present. No other abnormalities were noticed. Biochemistry tests showed signs of inflammation (CRP 106.9 mg/L), heart failure (NT pro-BNP: 11214 ng/L) and hyperco-agulable state (D-dimer 25). Fresh ischemic lesion of the right frontoparietal lobe was noticed on the CT. Thoracic X- ray showed multiple bilateral spots and an inhomogeneous shaded lung parenchyma. Also, during the CT angiography, multiple emboli were noticed in segmental pulmonary arteries. PCR of the sputum was ordered and the patient tested positive for tu-berculosis. The patient was treated with Rifampicin, Isoniazid and Pyrazinamide and two weeks later was discharged from hospital care. Pulmonary rehabilitation was recommended as a further course of treatment.CONCLUSION: Tuberculosis can affect almost any organ systems. If diagnosed and treated correctly, consequences can be minimized. Also, less common manifestations shouldn’t be overlooked, because if neglected, the outcome might be fatal.17th Croatian Student SummitLiječ Vjesn 2022; godište 144; (Supl. 2)73CASE REPORTS

Lymphocytic interstitial pneumonitis (LIP) as an extraglandular manifestation of primary Sjögren\u27s syndrome: a case report

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