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February 1976

Coexistent Lymphoid Interstitial Pneumonia, Pernicious Anemia, and Agammaglobulinemia: Comment on Autoimmune Pathogenesis

Author Affiliations

From the Section of Immunology, University of California, School of Medicine, San Francisco (Drs Levinson, Stites, Spitler, and Fudenberg), and the Chest Service, San Francisco General Hospital (Dr Hopewell).

Arch Intern Med. 1976;136(2):213-216. doi:10.1001/archinte.1976.03630020067014

The coexistence of lymphoid interstitial pneumonia, pernicious anemia and common variable hypogammaglobulinemia represents a disease triad not previously described. However, both pernicious anemia and lymphoid interstitial pneumonia have been independently associated with dysproteinemia,1-4 and both have features that tend to implicate immunologic alterations in their pathogenesis. The occurrence of these diseases in the same patient stimulated extensive evaluation of her immune system.

PATIENT SUMMARY  A 58-year-old woman was found to have pernicious anemia in 1960. The diagnosis was based on the findings of macrocytic red blood cell (RBC) indices, a megaloblastic bone marrow specimen, histamine-fast achlorhydria, abnormal Schilling test results, and correction of the anemia by vitamin B12. A chest roentgenogram showed middle lobe and lingular infiltrate characterized by "honeycombing" and also bilateral pleural thickening. At that time, her only pulmonary symptom was a mild dry cough. However, over the next several years she developed increasing dyspnea, and

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