A case of diffuse panbronchiolitis complicated by malignant thymoma and Sjögren's syndrome

Abstract

A patient with diffuse panbronchiolitis (DPB) complicated by malignant thymoma and Sjögren's syndrome with pseudolymphoma is reported. A 58-year-old woman developed productive cough, dyspnea and sicca in the mouth. Laboratory findings on admission indicated a high titer of cold hemagglutinin, positive of anti-DNA and negative PPD skin test. Chest-X ray revealed diffuse reticulonodular shadows in the lower lung field and anterior mediastinal mass shadow. Pulmonary function studies showed reduction of the vital capacity, forced expiratory volume in one second, DLco and hypoxia (PaO2; 69.1 Torr). Lung biopsy and resection were performed. Histologically infiltration of mononuclear cells and accumulation of foamy cells around respiratory bronchioles and stenosis of terminal bronchioles by granulation tissue was compatible with the diagnosis of DPB and the mediastinal tumor appeared to be a malignant thymoma invading to pericardium. Focal infiltration of lymphocytes was also recognized around the salivary glands (Sjögren's syndrome) and in the alveolar septa (pseudolymphoma). This case of DPB might have been associated with lymphoproliferative disorders.