Organizing pneumonia as the initial presentation of systemic lupus erythematosus in a Korean adolescent
10.4168/aard.2020.8.3.155
- Author:
So-Young KANG
1
;
Soo Yeon KIM
;
Sun Ha CHOI
;
In Suk SOL
;
Yoon Hee KIM
;
Hyo Sup SHIM
;
Mi-Jung LEE
;
Kyung Won KIM
;
Myung Hyun SOHN
Author Information
1. Departments of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Publication Type:CASE REPORT
- From:Allergy, Asthma & Respiratory Disease
2020;8(3):155-160
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Organizing pneumonia is characterized histologically by the formation of granulation-tissue plugs within the lumens of small airways. It was reported in association with various disorders including infection, drug reactions and collagen vascular diseases. However, there have been only a few reports on organizing pneumonia accompanied by systemic lupus erythematosus (SLE), especially in the pediatric population. Herein, we report a case of an adolescent with SLE who initially developed respiratory illnesses due to organizing pneumonia. A 14-year-old girl was referred to our clinic for protracted cough with fever, dyspnea, and hemoptysis. Her chest x-ray revealed predominant multifocal consolidations in bilateral lung fields with pleural effusion. Computed tomography scan showed patchy consolidations with surrounding ground-glass opacities and a crazy paving appearance with multiple centrilobular nodules. Laboratory tests exhibited pancytopenia, elevated blood urea nitrogen and creatinine, proteinuria, low serum levels of complements, and positivity for antinuclear antibody and anti-double-stranded DNA antibody, which were suggestive of SLE. Lung biopsy was performed to exclude the possibility of vasculitis and other mixed connective tissue diseases, which confirmed focal organizing pneumonia. Systemic steroid therapy, including high-dose methylprednisolone, was started. After the treatment, her respiratory symptoms and radiologic findings showed significant improvements. The patient has been followed up so far, and she has remined disease-free. This pediatric case of organizing pneumonia as the initial presentation of SLE alerts clinicians to consider thorough assessment of pulmonary manifestations of SLE in children.
