J Rheum Dis.  2013 Apr;20(2):118-122. 10.4078/jrd.2013.20.2.118.

Remission of Lymphocytic Interstitial Pneumonia in Sjogren's Syndrome after Autologous Peripheral Blood Stem Cell Transplantation

• Choi HN
• Choe JY
• Kim SH
• Kim SK
• Ryoo HM
• Park SH

• KMID: 2223037
• DOI: http://doi.org/10.4078/jrd.2013.20.2.118

Abstract

Interstitial pneumonia occurs in approximately 25% of patients with primary Sjogren's syndrome. Interstitial pneumonia combined with primary Sjogren's syndrome usually responds well to systemic steroids, and fatal cases are rare. Lymphocytic interstitial pneumonia shows diffuse infiltration of polyclonal B and T cells. Autologous stem cell transplantation is performed in cases of primary Sjogren's syndrome as an optional treatment when the condition responds poorly to conventional treatment. The hypothesis that primary Sjogren's syndrome improves after transplantation relies on the role of B-cell abnormalities in pathogenesis or the strong effects of immunosuppressive therapy. We experienced the case of a patient diagnosed with primary Sjogren's syndrome and lymphocytic interstitial pneumonia progression refractory to conventional treatment (steroid and immunosuppressive drugs) and cyclophosphamide pulse therapy. Our patient demonstrated improvement of lung manifestations and autoimmune disease activity after autologous stem cell transplantation.

Keyword

Sjogren's syndrome; Lymphocytic interstitial pneumonia; Stem cell transplantation

MeSH Terms

Autoimmune Diseases
B-Lymphocytes
Cyclophosphamide
Humans
Lung
Lung Diseases, Interstitial
Peripheral Blood Stem Cell Transplantation
Sjogren's Syndrome
Stem Cell Transplantation
Steroids
T-Lymphocytes
Transplants
Cyclophosphamide
Steroids

Figure

• 

  Figure 1. (A) Multiple cysts are found in various sizes on both upper and middle lobes of lung accompanied by multiple lymphadenopathy. (B) Small sized centrilobular nodules are found mainly on both lower lobes of lung. (C) HRCT taken 6 months after auto SCT. Inflammation was improved on both lung field, size and number of lymphadenopathy were all decreased. (D) Both size and number of centrilobular nodules presented on both lung fields were all decreased.

• 

  Figure 2. (A) 2×100 (H&E stain), (B) 4×400 (H&E stain). The section shows diffuse interstitial infiltration of lymphoid cells and plasma cells. Scattered small lymphoid follicles are present.

• 

  Figure 3. Presented the flow of CRP (mg/L) and ESR (mm/h) during observation periods of the patient. Performed cytoxan pulse therapy from March, 2007 to August, 2007. Performed VAD induction chemotherapy from March, 2009 to June, 2009. Performed autologous SCT in December, 2009.

Reference

References

1. Hatron PY, Tillie-Leblond I, Launay D, Hachulla E, Fauchais AL, Wallaert B. Pulmonary manifestations of Sjögren's syndrome. Presse Med. 2011; 40:e49–64.

2. Kokosi M, Riemer EC, Highland KB. Pulmonary involvement in Sjögren syndrome. Clin Chest Med. 2010; 31:489–500.

3. Kovács L, Szodoray P, Kiss E. Secondary tumours in Sjögren's syndrome. Autoimmun Rev. 2010; 9:203–6.

4. Hansen A, Daridon C, Dörner T. What do we know about memory B cells in primary Sjögren's syndrome? Autoimmun Rev. 2010; 9:600–3.

5. Mavragani CP, Moutsopoulos NM, Moutsopoulos HM. The management of Sjögren's syndrome. Nat Clin Pract Rheumatol. 2006; 2:252–61.

6. Nikolov NP, Pavletic SZ. Technology Insight: hematopoietic stem cell transplantation for systemic rheumatic disease. Nat Clin Pract Rheumatol. 2008; 4:184–91.

7. Meijer JM, Meiners PM, Vissink A, Spijkervet FK, Abdulahad W, Kamminga N, et al. Effectiveness of rituximab treatment in primary Sjögren's syndrome: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2010; 62:960–8.

8. Perl A. Emerging new pathways of pathogenesis and targets for treatment in systemic lupus erythematosus and Sjogren's syndrome. Curr Opin Rheumatol. 2009; 21:443–7.

9. Isshiki I, Okamoto S, Kakimoto T, Chen CK, Mori T, Yokoyama K, et al. Recurrence of autoimmune disease after autologous peripheral blood stem cell transplantation for multiple myeloma. Int J Hematol. 2006; 84:354–8.

10. Ferraccioli G, Damato R, De Vita S, Fanin R, Damiani D, Baccarani M. Haematopoietic stem cell transplantation (HSCT) in a patient with Sjögren's syndrome and lung malt lymphoma cured lymphoma not the autoimmune disease. Ann Rheum Dis. 2001; 60:174–6.

11. Kaneko H, Ohkawara Y, Taniguchi K, Matsumoto Y, Nomura K, Horiike S, et al. Simultaneous complication of multiple myeloma with Sjögren syndrome. Asian Pac J Allergy Immunol. 2006; 24:245–8.