The Puzzling Coexistence of Eosinophilic Pneumonia With Sjogren’s Syndrome: A Diagnostic Dilemma

TL;DR

A patient with both eosinophilic pneumonia and Sjogren’s syndrome presented a diagnostic challenge, requiring careful treatment decisions.

Contribution

Highlights the diagnostic complexity when eosinophilic pneumonia and Sjogren’s syndrome coexist in a patient.

Findings

A patient presented with acute respiratory failure and labs indicating both eosinophilic pneumonia and primary Sjogren’s syndrome.

Treatment was adjusted from rituximab to mepolizumab after multidisciplinary discussion to target the dominant disease process.

The case illustrates the difficulty in determining which condition is driving the symptoms when both are present.

Abstract

We present a case where a patient with no significant pulmonary nor autoimmune medical history presents with acute hypoxic respiratory failure and a dry cough that's made worse when conversing. She gets diagnosed with eosinophilic pneumonia after bronchoalveolar lavage (BAL) showed 70% eosinophils while also having labs highly suggestive of primary Sjogren's syndrome (pSS) with an anti-SSA titer of 111.3 U/mL and anti-SSA 52 kD Ab, immunoglobulin (Ig)G >200 U. The initial treatment plan was to start rituximab to target primary Sjogren's syndrome associated interstitial lung disease (pSS-ILD), however after close discussion with pulmonology, it was changed to mepolizumab to target eosinophilic pneumonia. From a diagnostic standpoint, it may be tricky to determine which disease process is driving the symptoms especially when the patient has labs that are convincing for both.

Figures