Chronic diffuse pulmonary fibrosis has previously been reported as a feature of systemic lupus erythematosus (1-5). However, the histologic finding of granulomas in the lungs of patients with systemic lupus erythematosus has been rarely reported (6). We report a patient with clinical and laboratory features of systemic lupus erythematosus who, on the basis of noncaseating granulomas found at lung biopsy, was diagnosed as having sarcoidosis.Case report. EB, a 62-year-old white woman, was well until age 25 years when she developed gradual onset of pain in the shoulders, wrists, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, knees, ankles, and metatarsophalangeal (MTP) joints. These joint pains were persistent until she was 30 and then became episodic. At 29 she developed hypothyroidism and has received thyroid replacement since then. At age 48 years she developed dry eyes and mouth.In 1971 at age 54 years she presented with episodic polyarthritis, dry eyes and mouth, increased hair loss in the temporal regions, a cough productive of clear sputum, and progressive exertional dyspnea for 1 year. On examination corneal irregularities were demonstrated by rose bengal staining consistent with abnormal Addres reprint requests to Dr. Thomas Hunter, University of Manitoba Rheumatic Disease Unit, 800 Sherbrook Street, Winnipeg, Manitoba R3A IM4, Canada.Submitted for publication July 3, 1979 accepted in revised form November I, 1979. tear production. Late inspiratory rales were auscultated at both lung bases. Musculoskeletal examination showed diffuse tenderness of the hands with soft tissue swelling over the dorsum of both wrists and tenderness of the MTP joints. Laboratory investigations included hemoglobin 12.7 gm%, WBC 5,600/mm3, platelet count 190,000/mm3, and ESR 85 mm/hour (modified Wintrobe). Results of the latex fixation test were negative. Antithyroglobulin antibodies were not detected. The fluorescent antinuclear antibody test (FANA) was positive with a diffuse pattern. Multiple sputum cultures for acid fast bacilli and fungi gave negative results.Lung function tests showed a reduction in lung volumes. The total lung capacity was 68% of predicted and the vital capacity was 73% of predicted. The airflow rates were preserved with a forced expiratory volume in one second (FEV,) 78% of predicted and an FEV, to vital capacity ratio of 0.88. The transfer factor for carbon monoxide measured by the single breath test was 7.7 ml/mmHg with a predicted value of 12.9 ml/mmHg. The patient was mildly hypoxic at rest (arterial oxygen tension 65 mmHg). Lung compliance was markedly reduced to 0.07 liters/cm H,O (predicted 0.2 liters/cm H,O), indicating increased lung elastic recoil. These values are compatible with moderately advanced pulmonary fibrosis or interstitial lung disease and did not appreciably change after corticosteroid therapy or during 8 years of observation.Radiographs of the chest showed bilateral hilar lymphadenopathy and multiple small reticulonodular densities scattered throughout both ...
