Chronic hemoptysis leading to the diagnosis of inflammatory bronchiolitis in primary sjögren's syndrome: A case report

Introduction: Sjögren's syndrome (SS) is a chronic autoimmune inflammatory disease primarily affecting the exocrine glands. While airway involvement and interstitial lung disease are the most common respiratory manifestations, cellular bronchiolitis remains a rare complication of SS. We present a case of Sjögren's syndrome associated with cellular bronchiolitis, revealed by chronic hemoptysis.

Observation: Case Report. A 57-year-old patient was admitted for evaluation of cellular bronchiolitis, presenting with a chronic dry cough complicated by mild hemoptysis and progressively worsening dyspnea. The diagnosis of Sjögren's syndrome was confirmed based on objective and subjective xerostomia, xerophthalmia with an abnormal Schirmer test, positive antinuclear antibodies (1:320), and strongly positive anti-SSa antibodies. Chest Computed Tomography ( CT ) imaging revealed findings consistent with cellular bronchiolitis. Pulmonary function tests (PFTs) demonstrated a moderate obstructive syndrome, with a forced vital capacity of 71%. The patient was treated with inhaled and systemic corticosteroids (prednisone 1 mg/kg/day), resulting in rapid clinical improvement.

Conclusion: Bronchiolar involvement in Sjögren's syndrome is often underdiagnosed and is typically associated with follicular bronchiolitis. Its prevalence varies widely. Dry cough and dyspnea are the primary symptoms of pulmonary involvement, while hemoptysis, though rare in this context, necessitates the exclusion of other differential diagnoses. High-resolution chest CT is essential for identifying distal airway involvement. Sjögren's syndrome should be considered in all patients presenting with chronic bronchiolar diseases.