[Diffuse thickening of bronchial walls with multiple nodular mucosal protrusions]

Area of Science:

• Rheumatology
• Pulmonology
• Otolaryngology

Background:

• Sjögren's syndrome is a chronic autoimmune disease primarily affecting exocrine glands.
• Airway involvement in Sjögren's syndrome typically manifests as peripheral airway disease.
• Central airway involvement, particularly with nodular lesions, is uncommon in Sjögren's syndrome.

Observation:

• A 58-year-old woman presented with chronic respiratory symptoms and xerostomia.
• Physical examination revealed enlarged salivary glands and lymph nodes, with lung rales.
• Sialography and biopsy confirmed Sjögren's syndrome with lymphocytic infiltration.

Findings:

• Chest CT and bronchoscopy identified diffuse thickening and macroscopic nodules in the trachea and main bronchi.
• Endobronchial biopsy confirmed lymphocytic infiltration of the bronchial submucosa.
• The patient responded dramatically to glucocorticoid therapy, with regression of airway lesions and systemic symptoms.

Implications:

• This case demonstrates a rare presentation of Sjögren's syndrome involving central large-airway disease with nodular formation.
• Early diagnosis and treatment with glucocorticoids can lead to significant improvement in airway manifestations.
• Highlights the importance of considering Sjögren's syndrome in patients with unexplained airway nodules and autoimmune symptoms.