Pulmonary involvement in Sjogren's syndrome: a case report
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A 58-year-old lady presented to pulmonary medicine outpatient department with complaints of cough and shortness of breath for 5 months. Cough was dry in nature and there was no diurnal variation. She had exertional shortness of breath which was gradually worsening over the last 5 months. There was no history of hemoptysis, chest pain, or constitutional symptoms.

She had polyarthralgias involving both large (knee, elbow) and small joints (hands and wrists) which was not associated with morning stiffness or joint swelling. The patient also had a history of dryness of eyes and mouth for 4 years. There were no significant occupational exposures and the patient was a lifetime never-smoker. A history of hypothyroidism was present for the last 3 years which was well controlled with treatment.

On respiratory system examination, bilateral fine crackles were audible. Rest of the general physical and systemic examination was unremarkable. On eye examination, Schirmer's test was positive objectively confirming the presence of dry eye. On further evaluation, anti-Ro and anti-La antibodies were found positive in high titers. Anti-thyroid peroxidase antibody titers were also elevated.

Pulmonary function test demonstrated mild restrictive defect (forced vital capacity 68% predicted) with diffusion impairment (Diffusion capacity for carbon monoxide (DLCO) 57% predicted). High-resolution computed tomography (HRCT) scan of the thorax was performed.

The lung window sections of the thoracic HRCT scan demonstrateD bilateral diffuse cysts with extensive ground glass opacities (GGOs) along with centrilobular nodules. Ahe was diagnosed with Lymphocytic interstitial pneumonia (LIP) associated with Sjogren's syndrome (SS).

Patient was advised cryoprobe lung biopsy for definite diagnosis but did not consent for the procedure. Treatment with oral corticosteroid therapy was initiated.

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