Bronchiolitis obliterans organising pneumonia as an initial manifestation in a patient with systemic lupus erythematosus: a rare presentation

Document Type

Article

Publication Date

5-26-2018

Publication Title

BMJ Case Rep

Keywords

Aged, 80 and over, Antibodies, Antinuclear, Cryptogenic Organizing Pneumonia, Humans, Lupus Erythematosus, Systemic, Male, Pericardial Effusion, Pleural Effusion, Pneumothorax

Abstract

Bronchiolitis obliterans organising pneumonia as an initial manifestation of systemic lupus erythematosus (SLE) is a rare and uncommon presentation. We describe a case of SLE presenting with shortness of breath, found to have pneumothorax, bilateral nodular infiltrates along with pleural effusions and pericardial effusion. Work-up suggested a diagnosis of active SLE with anaemia, thrombocytopenia, positive antinuclear antibodies (ANAs) and positive anti-double-stranded DNA. On retrospective review of patient records, from 8 years prior to presentation, lung biopsy histology consistent with bronchiolitis obliterans organising pneumonia with positive ANA serology was found, without any further autoimmune work-up. In our opinion, bronchiolitis obliterans organising pneumonia was the index presentation of SLE. Treatment with steroids and subsequent management with immunosuppressive therapy could have prevented subsequent hospitalisations. Prompt work-up for autoimmune diseases should be considered in patients with positive ANA and histological evidence of bronchiolitis obliterans organising pneumonia.

Medical Subject Headings

Aged, 80 and over; Antibodies, Antinuclear; Cryptogenic Organizing Pneumonia; Humans; Lupus Erythematosus, Systemic; Male; Pericardial Effusion; Pleural Effusion; Pneumothorax

PubMed ID

29804073

Volume

2018

Issue

May 26

First Page

bcr-2017-224094

Find It @ Sladen

Share

COinS