Liang Jessica, Shapoo Mazhar, Rasendrakumar Arabi
Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA.
Rheumatology, Wayne State University Detroit Medical Center, Detroit, USA.
Cureus. 2024 Jul 13;16(7):e64470. doi: 10.7759/cureus.64470. eCollection 2024 Jul.
We present a case where a patient with no significant pulmonary nor autoimmune medical history presents with acute hypoxic respiratory failure and a dry cough that's made worse when conversing. She gets diagnosed with eosinophilic pneumonia after bronchoalveolar lavage (BAL) showed 70% eosinophils while also having labs highly suggestive of primary Sjogren's syndrome (pSS) with an anti-SSA titer of 111.3 U/mL and anti-SSA 52 kD Ab, immunoglobulin (Ig)G >200 U. The initial treatment plan was to start rituximab to target primary Sjogren's syndrome associated interstitial lung disease (pSS-ILD), however after close discussion with pulmonology, it was changed to mepolizumab to target eosinophilic pneumonia. From a diagnostic standpoint, it may be tricky to determine which disease process is driving the symptoms especially when the patient has labs that are convincing for both.
一名既往无显著肺部疾病及自身免疫性疾病病史的患者出现急性低氧性呼吸衰竭，伴有干咳，交谈时加重。支气管肺泡灌洗（BAL）显示嗜酸性粒细胞占70%，同时实验室检查高度提示原发性干燥综合征（pSS），抗SSA滴度为111.3 U/mL，抗SSA 52 kD抗体，免疫球蛋白（Ig）G>200 U，该患者被诊断为嗜酸性粒细胞性肺炎。最初的治疗方案是开始使用利妥昔单抗治疗原发性干燥综合征相关间质性肺病（pSS-ILD），然而，在与肺病科密切讨论后，改为使用美泊利单抗治疗嗜酸性粒细胞性肺炎。从诊断的角度来看，确定是哪种疾病过程导致症状可能很棘手，尤其是当患者的实验室检查结果对两种疾病都有说服力时。
