Lymphocytic interstitial pneumonitis with infective exacerbation of bronchiectasis

Case contributed by Dr Rachael O'Rourke

Presentation

Wheeze with infective symptoms. ? LRTI. Previous CT suggests bronchiectasis. Known Sjogren's Syndrome.

Patient Data

Age: 49
Gender: Female

Right mid zone thin walled cystic lesion.

Bilateral mid to lower zone airspace opacities.

Initial chest film requested by the emergency department shows a right sided cystic structure with superimposed bilateral airspace opacification, concerning for infection.

Follow up CT chest ordered by the respiratory team to assess for bronchiectasis, demonstrates bronchiectasis with plugging and surrounding ground glass opacification, indicative of infective exacerbation, on a background of multiple, thin walled cysts scattered throughout the lung. Further interrogation of the patient's previous medical history revealed a previous diagnosis of Sjogren's.

Case Discussion

Scattered thin walled cysts of varying sizes is a typical appearance for lymphocytic interstitial pneumonitis in a patient with known Sjogren's syndrome. In the setting of treatment with immunosuppressive therapy, the development of bronchiectasis with accompanying ground glass opacification raises the possibility of infection with atypical organisms, such as fungal or mycobacterium.

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Case Information

rID: 38069
Case created: 3rd Jul 2015
Last edited: 5th Dec 2016
System: Chest
Inclusion in quiz mode: Included

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