Effective treatment of inhaled corticosteroid and bronchodilator for “lymphocytic interstitial pneumonia” in primary Sjögren's syndrome

• Published in: Respiratory medicine case reports 2024, Vol.47, p.101969, Article 101969
• Main Authors: Moriuchi, Yuki, Yanagihara, Toyoshi, Ogata, Hiroaki, Amemiya, Mitsuo, Ogawa, Aimi, Ishimatsu, Akiko, Otsuka, Junji, Taguchi, Kazuhito, Kadowaki, Masako, Maemura, Hiromasa, Moriwaki, Atsushi, Yoshida, Makoto
• Format: Article
• Language: English
• ISSN: 2213-0071; 2213-0071
• DOI: 10.1016/j.rmcr.2023.101969

We present a case of an 86-year-old woman who visited our hospital with a one-year history of exertional dyspnea (modified medical research council dyspnea scale; mMRC grade 2). Despite the absence of any smoking or dust exposure history, multiple cystic lesions were apparent in both lungs on her CT scan. We suspected Sjögren's syndrome-associated lymphocytic interstitial pneumonia (LIP) due to her additional symptoms of dry mouth and eyes. Her respiratory function test showed a restrictive disorder with a forced vital capacity (FVC) of 1.23 L (70.3 % predicted), forced expiratory volume in 1 s (FEV1) of 0.88 L, and FEV1/FVC of 71.5 %. The flow-volume curve showed a downward convex, suggesting peripheral airway obstruction. We initiated a daily inhalation treatment regimen comprising vilanterol 25 μg and fluticasone furoate 200 μg. One month later, at the follow-up visit, the clinical diagnosis of Sjögren's syndrome with LIP was made by positive SS-A and SS-B antibodies in the initial blood work, a Saxon test that confirmed decreased salivary secretion, and a confirmed diagnosis of dry eyes by her ophthalmologist. We noted improvement in FVC of 1.45 L (+17.8 %) and FEV1 to 0.99 L (+12.5 %) in the subsequent respiratory function test, along with alleviation of her symptoms. The present case represents the first report of LIP treated exclusively with inhaled corticosteroids and bronchodilators, highlighting a potential therapeutic approach, particularly for elderly patients vulnerable to immunosuppressive therapies.