Cryptogenic Organising Pneumonia As The Initial Presenting Manifestation of SLE

Neena Mampilly, G Manoj, Binoy Paul
2015 Case Report BMH Medical Journal   unpublished
Cryptogenic Organising Pneumonia (COP), also called idiopathic Bronchiolitis Obliterans Organising Pneumonia(BOOP), is a distinct entity among the idiopathic interstitial pneumonias defined histopathologically by intraalveolar buds of granulation tissue. The etiology includes idiopathic, infectious, drug induced radiation induced and connective tissue diseases. Organising pneumonia occurs particularly in patients with dermatomyositis-polymyositis where it may be the presenting manifestation,
more » ... g manifestation, and rarely in SLE, rheumatoid arthritis, scleroderma and other connective tissue diseases. We describe a 30 yr old lady who initially presented with respiratory symptoms, not responding to antibiotics. She was subsequently diagnosed as SLE and HRCT thorax showed consolidation involving both lung fields. A percutaneous lung biopsy revealed features of Cryptogenic Organising Pneumonia. A 30-year old female was admitted in a local hospital with fever, right sided chest pain, cough and breathlessness of 5 days duration. Physical examination and chest X-ray (Figure 1) was suggestive of right lobar pneumonia and she was put on Coamoxyclav. In spite of antibiotics, fever was persisting and lung signs extended to left side. Repeat X-ray chest showed nonhomogenous opacity extending to the lower zones of both lung (Figure 2). Hence ceftriaxone was also added to coamoxyclav. However fever was persisting and patient developed erythematous facial rash suggestive of malar rash of systemic lupus erythematosus (SLE). ANA (IIF) and antidsDNA done were found to be positive. Meanwhile the patient started developing dyspnoea and tachycardia and was referred to our centre. ECG taken was suggestive of atrial flutter. Echocardiography done showed global left ventricular dysfunction, normal valves, no vegetations. D-dimer test was negative. Patient was diagnosed as myocarditis secondary to SLE and put on ACE inhibitor and diuretics. Anticardiolipin antibody (IgG, IgM) and lupus anticoagulants were negative. Renal and liver function tests and urine examination were normal.