Lymphocytic interstitial pneumonitis

SMC and Dr Yuranga Weerakkody et al.

Lymphocytic interstitial pneumonitis is a benign lymphoproliferative disorder characterized by lymphocyte predominant infiltration of the lungs. It is classified as a subtype of interstitial lung disease. It also falls under the umbrella of non-lymphomatous pulmonary lymphoid disorders.

Lymphocytic interstitial pneumonitis can occur at any age. However, most of the patients are adults with a mean age of 50 years. If a child presents with lymphocytic interstitial pneumonitis, this can be indicative of AIDS.

There is a recognized female predilection most likely attributable to the fact that lymphocytic interstitial pneumonitis occurs in patients with autoimmune disease such as Sjögren syndrome, which is by far more common in women 8.

The main clinical symptoms are a gradual onset of dyspnea and cough with approximately six months duration. Less frequently, patients may have systemic symptoms such as fever, night sweat, arthralgia, and weight loss. If the disease progresses to the end-stage respiratory failure cyanosis and clubbing may develop. Hypertrophy of the salivary glands observed in 20% of patients 11

There is diffuse infiltration of the interstitium and alveolar spaces by lymphocytes and plasma cells.

In about 80% of patients polyclonal or IgM monoclonal gammopathy is found 8.

Features can be non-specific, but may include:

The following features may be seen with lymphocytic interstitial pneumonitis on HRCT, but the findings are not exclusive to its diagnosis:

The natural history is variable, from near-complete resolution to progressive disease. More than 30% of patients will develop the end-stage disease and honeycombing despite treatment.

Transformation to lymphoma can occur, particularly in a patient with monoclonal gammopathy or hypogammaglobulinemia 8. Corticosteroids have been successfully trialled 1.

General imaging differential considerations include:


Article information

rID: 8000
System: Chest
Synonyms or Alternate Spellings:
  • Lymphoid interstitial pneumonia
  • Lymphocytic interstitial pneumonitis
  • Lymphocytic interstitial pneumonia (LIP)
  • LIP
  • Lymphocytic interstitial pneumonia
  • Lymphoid interstitial pneumonia (LIP)
  • Lymphocytic interstitial pneumonitis (LIP)

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Cases and figures

  • Figure 1: illustration
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  • LIP
    Case 1: radiograph - background Sjogren syndrome
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  • Case 1: CT - showing thin walled cysts
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  • Case 2: with predominantly ground glass changes
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  • Case 3
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  • Case 4
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  • Case 5: SLE
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  • Multiple, thinned...
    Case 6: multiple pulmonary cysts
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  • Case 6: radiograph
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  • Case 8: in Sjogren's syndrome
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  • Case 9
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  • Case 10
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