A 66-year-old woman was referred to us for evaluation of an asymptomatic nodule in
the lung that had been detected through computed tomography (CT) examination during
routine unit physical examination. A solitary focal nodule with halo sign (blue arrow)
was demonstrated in the right upper lobe, 1.4 cm in diameter (Fig. 1A). Repeat CT 1 month later (Fig. 1B-D) showed subsequent multiple pulmonary shadows (red arrows). The patient had been
diagnosed with depression 3 years ago and had been receiving long-term medications,
such as mirtazapine, escitalopram oxalate, and lorazepam. She had no history of tuberculosis
and was otherwise well. Laboratory examinations were normal, including blood routine,
C-reactive protein, erythrocyte sedimentation rate and tumor markers. Photomicrograph
of a lung biopsy (Fig. 1E-F) indicated massive fibrous tissue hyperplasia in the lung tissue and organizing
pneumonia was diagnosed. Antipsychotic drugs were discontinued, and prednisone (1
mg/kg/day) was introduced. Repeat CT 6 days later (Fig. 1G) and 1 month later (Fig. 1H) detected a significant improvement (yellow arrows).
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References
- Organizing pneumonia induced by tocilizumab in a patient with rheumatoid arthritis.Cureus. 2020; 12: e6982
- Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications.AJR Am J Roentgenol. 2003; 180: 1251-1254
Article info
Publication history
Published online: January 23, 2022
Accepted:
January 20,
2022
Received:
October 7,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
