Coexistent Lymphoid Interstitial Pneumonia, Pernicious Anemia, and Agammaglobulinemia

Abstract

The coexistence of lymphoid interstitial pneumonia, pernicious anemia and common variable hypogammaglobulinemia represents a disease triad not previously described. However, both pernicious anemia and lymphoid interstitial pneumonia have been independently associated with dysproteinemia,^1-4and both have features that tend to implicate immunologic alterations in their pathogenesis. The occurrence of these diseases in the same patient stimulated extensive evaluation of her immune system. <h3>PATIENT SUMMARY</h3> A 58-year-old woman was found to have pernicious anemia in 1960. The diagnosis was based on the findings of macrocytic red blood cell (RBC) indices, a megaloblastic bone marrow specimen, histamine-fast achlorhydria, abnormal Schilling test results, and correction of the anemia by vitamin B₁₂. A chest roentgenogram showed middle lobe and lingular infiltrate characterized by "honeycombing" and also bilateral pleural thickening. At that time, her only pulmonary symptom was a mild dry cough. However, over the next several years she developed increasing dyspnea, and