Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma associated with coeliac disease

Pulmonary mucosa-associated lymphoid tissue (pMALT) lymphomas are rare, representing <1% of lung malignancies. An association between pMALT and autoimmune conditions has been described, but there is a paucity of documented cases linked to coeliac disease. We present the case of a patient with a history of coeliac disease who presented with weight loss but no respiratory symptoms. CT revealed diffuse endobronchial opacities with associated bronchial dilation and pulmonary nodules. Bronchoscopy confirmed widespread polypoid endobronchial lesions. Histology demonstrated diffuse lymphoid infiltrate which stained positive for CD20. Clonality studies confirmed low grade B cell MALT lymphoma. She was treated with anti CD20 monoclonal antibody, rituximab. Prognosis of pMALT is good with 5-year survival >80%. Thus, an index of suspicion and early detection are vital. This case highlights that pMALT should be considered in patients with non-specific symptoms and coeliac disease. Bronchoscopy is a valuable diagnostic tool to be used in these cases.