MYCOPHENOLATE MOFETIL-INDUCED PULMONARY NODULES

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pulmonary nodules are common and usually found incidentally in about 20-50 % Chest Computed Tomography (CT) scans screening trials.[1] Evaluation of is necessary as differential broad includes malignancy, infectious diseases like tuberculosis (TB), hamartomas, sarcoidosis, wegner's granulomatosis, granulomas.[2] There have been cases reporting mycophenolate mofetil (MMF) induced lymphoproliferative lymphoid neoplasms, mostly central nervous system, rarely lungs, but no which shown only lung lesion the form nodule caused by MMF.[3] We presenting a rare case MMF pulmonary nodules. CASE PRESENTATION: A 73 year non smoker female with 14 history diffuse scleroderma interstitial disease, esophageal dysmotility, Raynaud's disease digital ulceration multiple joint pains, on for 9 years, esomeprazole, antihypertensives intermittently methotrexate nintedanib short period time. She was accidentally to large right shoulder XRay, done evaluation pain. Subsequently CT showed multifocal bilateral mass opacities cavitary lesions, largest apical left upper lobe, measuring 4.4 x 2.7 3.9 cm lower lobe 3.3 3.8 3.1 cm. Positive Emission revealed abnormal uptake 3 lung. 2 weeks Amoxicillin-clavunate followed metronidazole given possibility aspiration pneumonia. interval change XRay. Quantiferon gold TB workup infection vasculitis associated her autoimmune condition were unremarkable. Biopsy negative marked fibrosis predominantly chronic (round cell) inflammatory cell infiltrate parenchyma/bronchial mucosa. Her discontinued. Serial chest at months intervals continual decrease size essentially all masses. DISCUSSION: very differential. In our patient, considerations process, hematogenous or aspiration. remains main diagnostic approach, malignancy. also treated antibiotics pneumonia, though lesions not typical position improvement imaging. Infectious work up Furthermore, after stopping indicates related CONCLUSIONS: patients nodules, should be REFERENCE #1: Au-Yong I T H, Hamilton W, Rawlinson J, Baldwin D R. BMJ 2020; 371 :m3673 doi:10.1136/bmj.m3673 #2: Edward Y. Chan, Puja Gaur, Yimin Ge, Lisa Kopas, Jose F. Santacruz, Nakul Gupta, Reginald Munden, Philip T. Cagle, Min P. Kim; Management Solitary Nodule. Arch Pathol Lab Med 1 July 2017; 141 (7): 927–931. doi: https://doi.org/10.5858/arpa.2016-0307-RA #3: Kobe Ito A, Hayata Nishimura K, Ueda Y, Ishida Mycophenolate Mofetil-induced Diffuse Large B-cell Lymphoma Which Lung Nodule Remitted Spontaneously. Intern Med. 2021;60(1):131-136. doi:10.2169/internalmedicine.5027-20 DISCLOSURES: disclosure file Wei Bin; No relevant relationships Devashish Desai, source=Web Response Pushti Khandwala, Sachi Singhal,