Diffuse interstitial pneumonitis as a revealing manifestation of systemic lupus erythematosus: A case report

Pulmonary fibrosis is a rare manifestation of systemic lupus erythematosus (SLE), occurring in 3 to 9% of cases, and is rarely the initial presenting symptom of the disease. Its pathophysiology remains poorly understood, and its clinical and radiological presentation resembles that of other connective tissue diseases. It is often associated with multi-organ involvement.

The article presents the case of a 64-year-old woman with no significant medical history, hospitalized for stage III dyspnea (according to Sadoul), dry cough, and fatigue, all evolving over six years. Her medical history revealed photosensitivity and inflammatory polyarthralgia of the large joints. Biological tests showed an inflammatory syndrome, leukopenia, and positive antinuclear and anti-DNA antibodies, which led to the diagnosis of systemic lupus erythematosus (SLE) based on the ACR criteria (photosensitivity, lymphopenia, positive antinuclear antibodies, and positive anti-DNA antibodies).

Imaging studies (chest X-ray and CT scan) revealed bilateral diffuse pulmonary fibrosis, with a honeycomb appearance and thickening of the septal lines. Pulmonary function tests showed a restrictive syndrome. The diagnosis of pulmonary fibrosis associated with SLE was confirmed. The patient was treated with corticosteroids and an immunosuppressant, with stable disease progression.

In summary, this case illustrates the complexity of diagnosing pulmonary fibrosis in the context of systemic lupus erythematosus, a rare but serious condition that requires a multi-faceted approach to management.