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Moriuchi Y, Yanagihara T, Ogata H, Amemiya M, Ogawa A, Ishimatsu A, Otsuka J, Taguchi K, Kadowaki M, Maemura H, Moriwaki A, Yoshida M. Effective treatment of inhaled corticosteroid and bronchodilator for "lymphocytic interstitial pneumonia" in primary Sjögren's syndrome. Respir Med Case Rep 2023; 47:101969. [PMID: 38188624 PMCID: PMC10767271 DOI: 10.1016/j.rmcr.2023.101969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024] Open
Abstract
We present a case of an 86-year-old woman who visited our hospital with a one-year history of exertional dyspnea (modified medical research council dyspnea scale; mMRC grade 2). Despite the absence of any smoking or dust exposure history, multiple cystic lesions were apparent in both lungs on her CT scan. We suspected Sjögren's syndrome-associated lymphocytic interstitial pneumonia (LIP) due to her additional symptoms of dry mouth and eyes. Her respiratory function test showed a restrictive disorder with a forced vital capacity (FVC) of 1.23 L (70.3 % predicted), forced expiratory volume in 1 s (FEV1) of 0.88 L, and FEV1/FVC of 71.5 %. The flow-volume curve showed a downward convex, suggesting peripheral airway obstruction. We initiated a daily inhalation treatment regimen comprising vilanterol 25 μg and fluticasone furoate 200 μg. One month later, at the follow-up visit, the clinical diagnosis of Sjögren's syndrome with LIP was made by positive SS-A and SS-B antibodies in the initial blood work, a Saxon test that confirmed decreased salivary secretion, and a confirmed diagnosis of dry eyes by her ophthalmologist. We noted improvement in FVC of 1.45 L (+17.8 %) and FEV1 to 0.99 L (+12.5 %) in the subsequent respiratory function test, along with alleviation of her symptoms. The present case represents the first report of LIP treated exclusively with inhaled corticosteroids and bronchodilators, highlighting a potential therapeutic approach, particularly for elderly patients vulnerable to immunosuppressive therapies.
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Affiliation(s)
- Yuki Moriuchi
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Toyoshi Yanagihara
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Hiroaki Ogata
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Mitsuo Amemiya
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Aimi Ogawa
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Akiko Ishimatsu
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Junji Otsuka
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Kazuhito Taguchi
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Masako Kadowaki
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Hiromasa Maemura
- Department of Radiology, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Atsushi Moriwaki
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
| | - Makoto Yoshida
- Department of Respiratory Medicine, NHO Fukuoka National Hospital, Fukuoka, Japan
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Guarneri A, Perrone E, Bosello SL, D'Agostino MA, Leccisotti L. The role of PET/CT in connective tissue disorders: systemic sclerosis, Sjögren's syndrome and systemic lupus erythematosus. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:194-205. [PMID: 36066111 DOI: 10.23736/s1824-4785.22.03463-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Advanced imaging techniques are needed to help clinicians in the diagnosis, in the choice of the right time for therapeutic interventions or for modifications and monitoring of treatment response in patients with autoimmune connective tissue diseases. Nuclear medicine imaging, especially PET/CT and PET/MRI, may play an important role in detecting disease activity, assessing early treatment response as well as in clarifying the complex mechanisms underlying systemic sclerosis, Sjögren's syndrome or systemic lupus erythematosus. In addition, [18F]FDG PET/CT may help in excluding or detecting coexisting malignancies. Other more specific radiopharmaceuticals are being developed and investigated, targeting specific cells and molecules involved in connective tissue diseases. Further larger studies with standardized imaging protocol and image interpretation are strongly required before including PET/CT in the diagnostic work-up of subsets of patients with autoimmune connective tissue diseases.
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Affiliation(s)
- Andrea Guarneri
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisabetta Perrone
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia L Bosello
- Unit of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria A D'Agostino
- Unit of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Leccisotti
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy -
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
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