INTERSTITIAL LUNG DISEASE IN AN ELDERLY MAN WITH GIANT CELL ARTERITIS

Abstract

PURPOSE: To describe the association of interstitial lung disease (ILD) with giant cell arteritis (GCA). METHODS: Case report RESULTS: An 89-year-old never-smoker male with a history of polymyalgia rheumatica (PMR) on chronic low dose prednisone was later diagnosed with giant cell arteritis (GCA) confirmed by temporal artery biopsy. At the time of GCA diagnosis, the patient reported dyspnea and chest radiographs showed bilateral interstitial infiltrate with peripheral and basilar predominance. Chest computed-tomography (CT) performed several months later showed findings of a fibrosing interstitial pneumonia with mild traction bronchiectasis involving predominantly the bibasilar and peripheral lung zones, consistent with a probable usual interstitial pneumonia (UIP) pattern (Figure A). These findings were new compared to prior CT imaging four years before. Pulmonary function test (PFT) revealed a moderate restrictive pattern with forced vital capacity (FVC) 73% and diffusing capacity of the lungs for carbon monoxide (DLCO) 53%. The patient experienced improvement with increased prednisone dose. At follow up 6 months after hospitalization, repeat PFT revealed FVC 91% and DLCO 65%. Repeat chest CT showed that parenchymal infiltrates improved with decreased reticulation and resolution of ground-glass opacities (Figure B). CONCLUSIONS: The temporal relationship in this case suggests the association of GCA with ILD. Although the CT findings suggested a UIP pattern, the patient experienced improvement with prednisone treatment. CLINICAL IMPLICATIONS: In recent years there have been multiple reports of ILD or pulmonary fibrosis associated with small vessel vasculitis, especially ANCA-related vasculitis. This case suggests large vessel vasculitis may cause ILD and mimic idiopathic pulmonary fibrosis in the elderly.