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CASE REPORT
Bronchiolitis obliterans organising pneumonia as an initial manifestation in a patient with systemic lupus erythematosus: a rare presentation
  1. Shraddha Jatwani1,
  2. Richa Handa1,
  3. Karan Jatwani2,
  4. Karan Chugh3
  1. 1Henry Ford Allegiance Health, Jackson, Michigan, USA
  2. 2Mount Sinai Health System, New York City, New York, USA
  3. 3Wayne State University, Detroit, Michigan, USA
  1. Correspondence to Dr Shraddha Jatwani, shraddha.jatwani{at}gmail.com

Summary

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.

  • rheumatology
  • systemic lupus erythematosus
  • respiratory medicine
  • interstitial lung disease
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Footnotes

  • Contributors SJ: Conception and design, acquisition of data, analysisand interpretation of data, drafting of the manuscript and/or critical revisionof the manuscript for important intellectual content. RH: Conception anddesign, acquisition of data, analysis and interpretation of data, and draftingof the manuscript. KJ and KC: Analysis and interpretation of data, drafting ofthe manuscript and critical revision of the manuscript for importantintellectual content.

  • 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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