Evaluation of bilateral lung nodules noted on imaging poses a diagnostic challenge to clinicians as it can have many differentials from benign to malignant causes. It becomes especially critical to identify them right when there are underlying autoimmune conditions and risk factors for infection. However, a thorough investigation can lead to the recognition of rare associations as described below. We present here a 57-year-old woman who was admitted to the hospital with shortness of breath. Imaging with a computed tomography (CT) scan showed that she had 8 bilateral cystic pulmonary nodules with focal areas of ground-glass opacity and mediastinal lymphadenopathy. Fibrobronchoscopy and histopathological studies were done on the right middle lobe lung nodule demonstrated that the lung nodule was fibrotic with reactive inflammation but showed no malignant cells. Upon further detailed history and chart review, it was noted that the patient had a history of dry eyes leading to an autoimmune workup showing positive antinuclear antibodies (ANA), anti-Ro, and anti-La antibodies with no follow-up since then. This lead to the suspicion that these nodules could be related to underlying Sjögren’s syndrome. Initial inpatient management with intravenous steroids showed significant improvement in her symptomatology. Hence, we present this rare association of lung nodules with Sjögren’s syndrome and its management for awareness of this condition.
Sjögren’s syndrome (SS) is a chronic multisystem autoimmune disease originally described by Gougerot in 1926.
It is characterized mainly by keratoconjunctivitis sicca and mouth dryness secondary to lymphocytic infiltration of exocrine glands. Pulmonary involvement in SS is not uncommon, occurring in approximately 10 to 20% of patients, although lung nodules are a rare pulmonary manifestation of Sjögren’s syndrome, malignancy and infectious causes need to be ruled out as well. We present here a rare case of pulmonary nodules which were thought to be related to a malignancy; however, a biopsy of the lung nodule which was most suspicious of malignancy showed that it was of fibrotic nature and a remote history of dry eyes prompted an autoimmune workup revealing the cause to be related to Sjögren’s syndrome.