[Reversed halo sign in organizing pneumonia secondary to Sjögren syndrome]

We report a case of a 41-year-old woman admitted to our hospital for dyspnea on exertion and nonproductive cough. High-resolution computed tomography (HRCT) revealed central ground-glass opacities surrounded by ring-shaped areas of consolidation (reversed halo sign), predominantly in the lower lobes. Bronchoalveolar lavage fluid revealed an increase of the total number of cells (35 x 10(4)/ml), including elevated lymphocyte level (69%) and decreased CD4/CD8 ratio (0.45). Histopathological examination by transbronchial lung biopsy showed polypoid masses of granulation tissue filling the lumens of a respiratory bronchiole and alveolar ducts, consistent with organizing pneumonia. After admission the patient complained of dry eyes and dry mouth. The serum anti-SS-A antibody level was also elevated (65.0 U/ml). Labial salivary gland biopsy specimens revealed focal lymphocytic infiltration of more than 50 per 4 mm(2). There were no findings of rheumatoid arthritis or other collagen diseases. We diagnosed primary Sjögren syndrome with secondary organizing pneumonia with a reversed halo sign. She was treated with prednisolone (0.5 mg/kg body weight, 35 mg/day). After treatment, the chest CT showed improvement through consolidation.