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A 44-yr-old man with dyspnea (ATS Gr II)

A 44-yr-old man with dyspnea (ATS Gr II). Ex smoker 1 * 24 pack years, 1 년전 quit 1 년전부터 dyspnea 발생 당시 PFT : no abnormality 8 개월 전 모 대학병원에서 시행한 건강검진상 이상소견 없다고 들음 6 개월 전 CAG 시행상 이상소견 없다고 들음 (local H) 부정맥 (?) medication 15 일 정도후 medication stop

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A 44-yr-old man with dyspnea (ATS Gr II)

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  1. A 44-yr-old man with dyspnea (ATS Gr II) • Ex smoker 1 * 24 pack years, 1년전 quit • 1년전부터 dyspnea 발생 당시 PFT : no abnormality • 8개월 전 모 대학병원에서 시행한 건강검진상 이상소견 없다고 들음 • 6개월 전 CAG 시행상 이상소견 없다고 들음 (local H)부정맥(?) medication 15일 정도후 medication stop • 3개월 전부터 본원 IM3 OPD 내원CT 상 양쪽 폐에 lung에 GGO 보임.* CEA 17.3, FEV1 75% FVC 2.81(66%) • 직업: 공무원 • 체중감소: 13kg(76 -> 63)/1years • Arthralgia: both knee, ankle • Muscle weakness; Both lower extremity

  2. Progression Note • PFT- FVC 2.8(68)FEV1 2.29(69) FEV1/FVC 78% --> mild restrictive pattern • BAL: monocyte dominant(86%) • VAT’s lung biopsy 시행 • RF 85.1, FANA 2+, anti-Ro/SSA +(>200), Anti-CCP + 26.15 로 협진결과 Sjogren's SD 및 RA 에 대한 lung 이외의 증상 뚜렷하지 않아 lung lesion치료가 우선이며, Sjogren's SD 에 대해서는 예방적으로 HCQ 200mg bid 시작하기로 함 . • Initial CEA 12.2로 elevation, weight loss있어 hidden malignancy 가능성 있어 APCT시행하였으나, 이상소견 보이지 않았고, 연고지 병원에서 EGD, colonoscopy시행하기로 하고 퇴원함.

  3. Diffuse ground-glass opacities in both lungs with lower lobe predominancy 19650853

  4. Diffuse ground-glass opacities in both lungs 19650853

  5. Lung involvement of Sjogren’s syndorme, NSIP pattern Interstitial inflammation and fibrosis, slightly bronchiolocentric accentuation, relatively even disease age

  6. Lung involvement of Sjogren’s syndorme, NSIP pattern Interstitial inflammation and fibrosis, slightly bronchiolocentric accentuation, relatively even disease age

  7. Lung involvement of Sjogren’s syndorme, NSIP pattern Interstitial inflammation and fibrosis, slightly bronchiolocentric accentuation, relatively even disease age

  8. Lung involvement of Sjogren’s syndorme, NSIP pattern

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