# 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.

## Key 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.