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Pulmonary Nodular Lymphoid Hyperplasia Associated with Multiple Sclerosis
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A3062 - Pulmonary Nodular Lymphoid Hyperplasia Associated with Multiple Sclerosis
Author Block: D. Kay, D. R. Urbine; Pulmonary and Critical Care, University of Florida, Gainesville, FL, United States.
Introduction: Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare disease characterized by benign lesions of polyclonal lymphoid proliferation, often found incidentally on chest imaging. Most patients diagnosed with this condition are adult females who are asymptomatic with associated mediastinal or hilar lymphadenopathy. This condition has mostly been described as being associated with Sjogrens Syndrome. We present a case of a young female with biopsy proven PNLH associated with multiple sclerosis.
Case: Our patient is a 35 year old female with a past medical history of cough variant asthma, fibromyalgia, sleep apnea, irritable bowel syndrome, and recurrent tonsillitis. She initially presented with symptoms of worsening dyspnea and cough and was found to have multiple noncalcified bilateral lung nodules with peripheral ground-glass on chest CT. She underwent a bronchoscopy with transbronchial biopsies demonstrating focal intra-alveolar hemorrhage and focal chronic inflammation. Acid-fast bacteria (AFB) and Grocott's methenamine silver (GMS) stains were negative. An open lung biopsy ruled out non-hodgkins lymphoma through flow cytometry and the lack of evidence of clonal B or plasma cells on pathology. The pathology was consistent with a diagnosis of nodular lymphoid hyperplasia. The patient has been followed for 11 years with persistent bilateral lung nodules on CT, without significant change in size or distribution. The patient tested negative for Sjogren’s Syndrome but has been diagnosed with multiple sclerosis.
Discussion: Pulmonary nodular lymphoid hyperplasia is a rare condition, usually incidentally found on imaging and diagnosed through biopsy. Although this condition is benign, biopsy is often indicated to rule out malignancy or infection. An association between Sjogren’s Syndrome and PNLH has been described, however to our knowledge this is the second case reported of PNLH associated with multiple sclerosis. Further evaluation regarding the role of autoimmunity and PNLH should to be investigated including a survey of possible genetic mutations leading to such dysfunctions.
Author Block: D. Kay, D. R. Urbine; Pulmonary and Critical Care, University of Florida, Gainesville, FL, United States.
Introduction: Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare disease characterized by benign lesions of polyclonal lymphoid proliferation, often found incidentally on chest imaging. Most patients diagnosed with this condition are adult females who are asymptomatic with associated mediastinal or hilar lymphadenopathy. This condition has mostly been described as being associated with Sjogrens Syndrome. We present a case of a young female with biopsy proven PNLH associated with multiple sclerosis.
Case: Our patient is a 35 year old female with a past medical history of cough variant asthma, fibromyalgia, sleep apnea, irritable bowel syndrome, and recurrent tonsillitis. She initially presented with symptoms of worsening dyspnea and cough and was found to have multiple noncalcified bilateral lung nodules with peripheral ground-glass on chest CT. She underwent a bronchoscopy with transbronchial biopsies demonstrating focal intra-alveolar hemorrhage and focal chronic inflammation. Acid-fast bacteria (AFB) and Grocott's methenamine silver (GMS) stains were negative. An open lung biopsy ruled out non-hodgkins lymphoma through flow cytometry and the lack of evidence of clonal B or plasma cells on pathology. The pathology was consistent with a diagnosis of nodular lymphoid hyperplasia. The patient has been followed for 11 years with persistent bilateral lung nodules on CT, without significant change in size or distribution. The patient tested negative for Sjogren’s Syndrome but has been diagnosed with multiple sclerosis.
Discussion: Pulmonary nodular lymphoid hyperplasia is a rare condition, usually incidentally found on imaging and diagnosed through biopsy. Although this condition is benign, biopsy is often indicated to rule out malignancy or infection. An association between Sjogren’s Syndrome and PNLH has been described, however to our knowledge this is the second case reported of PNLH associated with multiple sclerosis. Further evaluation regarding the role of autoimmunity and PNLH should to be investigated including a survey of possible genetic mutations leading to such dysfunctions.
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