Reversed halo sign in organizing pneumonia secondary to Sjögren syndrome
Satoshi Anai1) Hiroyuki Kumazoe2) Kentarou Wakamatsu1) Nobuhiko Nagata3) Yoichi Nakanishi4) Akira Kajiki1)
1)Department of Respiratory Medicine, National Hospital Organization Omuta National Hospital 2)Department of Radiology, National Hospital Organization Omuta National Hospital 3)Department of Respiratory Medicine, Fukuoka University Chikushi Hospital 4)Research Institute for Diseases of the Chest, Kyushu University
We report a case of a 41-year-old woman admitted to our hospital for dyspnea on exertion and nonproductive cough. High-resolution computed tomography (HRCT) revealed central ground-glass opacities surrounded by ring-shaped areas of consolidation (reversed halo sign), predominantly in the lower lobes. Bronchoalveolar lavage fluid revealed an increase of the total number of cells (35×104/ml), including elevated lymphocyte level (69%) and decreased CD4/CD8 ratio (0.45). Histopathological examination by transbronchial lung biopsy showed polypoid masses of granulation tissue filling the lumens of a respiratory bronchiole and alveolar ducts, consistent with organizing pneumonia. After admission the patient complained of dry eyes and dry mouth. The serum anti-SS-A antibody level was also elevated (65.0 U/ml). Labial salivary gland biopsy specimens revealed focal lymphocytic infiltration of more than 50 per 4 mm2. There were no findings of rheumatoid arthritis or other collagen diseases. We diagnosed primary Sjögren syndrome with secondary organizing pneumonia with a reversed halo sign. She was treated with prednisolone (0.5 mg/kg body weight, 35 mg/day). After treatment, the chest CT showed improvement through consolidation.
Reversed halo sign Organizing pneumonia Primary Sjögren syndrome
Received 平成23年1月7日
JJRS, 49(9): 707-712, 2011