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Ro-positive interstitial lung disease treated with cyclophosphamide
  1. Nader Habib Bedwani1,2,
  2. Natasha Jefferson3,
  3. Christopher Marguerie4,
  4. Jayanta Mukherjee2
  1. 1University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  2. 2Department of Respiratory Medicine, Warwick Hospital, Warwick, UK
  3. 3Department of Radiology, Warwick Hospital, Warwick, UK
  4. 4Department of Rheumatology, Warwick Hospital, Warwick, UK
  1. Correspondence to Dr Nader Habib Bedwani, nader{at}


Interstitial lung disease (ILD) comprises a spectrum of conditions involving inflammation and/or fibrosis of the alveolar wall causing limitation in gaseous exchange. Treatment varies depending on the underlying ILD. We describe the case of a woman presenting with a productive cough who was diagnosed with community-acquired pneumonia. While on the ward she developed type-1 respiratory failure requiring continuous positive airway pressure and intensive care unit admission. Failing to respond to targeted antimicrobials she was investigated by chest high-resolution CT and autoantibody screen to identify non-infective causes of her respiratory signs and symptoms. These demonstrated diffuse ground-glass change with peripheral honeycombing in keeping with fibrosis and alveolitis alongside high titres of anti-SS-A/Ro antibodies. She was managed with reducing course of steroids and immunosuppression with cyclophosphamide. The rational of long-term immunosuppression was based on a presumed diagnosis of lung-dominant connective tissue disease, a disease concept proposed in contemporary medical literature.

  • interstitial lung disease
  • connective tissue disease
  • respiratory system

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  • Contributors NHB: drafted the manuscript; contributed to acquisition and analysis. NJ: identified and reported the images; critically revised the manuscript. CM: contributed to conception and design; contributing to editing of the manuscript. JM: contributed to conception and design; gave final approval of the manuscript for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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