Scleroderma with pulmonary nodules on CT scan: a rare case presentation

Abstract

A case is presented of a 30 year old gentleman, driver by occupation, who presented as an outdoor patient with pulmonary symptoms accompanied by left sided chest pain, other systemic complaints, and significant weight loss of 33 kgs over past few months associated with loss of appetite. Past history was significant for abdominal tuberculosis in 2014. He also gave history of alopecia and photophobia. On examination, chest was bilateral clear on auscultation and rest of the organ system findings were unremarkable. CBC showed anemia. Other baseline investigations were normal. Chest X-ray was done which showed bilateral asymmetrical irregular nodules in all lung zones. CT chest (without contrast) showed bilateral discrete peripheral nodules in upper and mid zones with hilar lymphadenopathy and mild pericardial effusion.

Image guided biopsy report showed inconclusive, non-specific chronic inflammation with fibrosis along with foci of excessive proliferation of atypical pneumocytes. Patient underwent Open lung pleural biopsy under general anesthesia, which revealed features seen in collagen vascular disease. Hence further clinical and serological evaluation was done which revealed Scl-70 of 11.06 (positive).

Patient was administered steroids. Interval regression of pulmonary nodules were noted after 4 months of commencement of steroids on subsequent CT chest films. Patient also showed significant clinical improvement and is currently under the treatment of Rheumatologist.