Pulmonary involvement of scleroderma presenting with nodules

Scleroderma is a generalized connective tissue disease characterised by inflammatory, vascular and fibrotic changes of skin and a variety of internal organs. Pulmonary disease is estimated to occur in 70% to 85% of patients with scleroderma. Lung involvement is usually seen as diffuse and bilateral basilar reticulonodular infiltrates. A 45 year old woman was admitted to the hospital because of coughing for a period one month and detected multiple, diffuse, irregular pulmonary nodules reported in chest computerised tomography. The thickening of the skin of the fingers, face and neck, sclerodactyly and the loss of substance from the finger pad were found in physical examination. No clinical or laboratory findings suggesting malignancy was found. Elevated liver function tests, antinuclear antibody, antimitochondrial antibody and anticentromer antibody were detected in blood analyse. In the bronchoalveolar lavage of the patient whose DLCO was decreased, 61% lymphocyte, 13% eosinophil was seen. The computerised tomography guided lung biopsy was reported as nonspecific interstitial pneumonia, liver biopsy was reported as portal inflammation and fibrosis. With these findings the patient was diagnosed as scleroderma and treated with cyclophosphamid and corticosteroid. At the end of the first month of the treatment nodular lesions were disappeared in the chest computerised tomography. With the unusual radiologic manifestation, scleroderma should be also considered in the etiology of multipl pulmonary nodules.