A case of pulmonary hyalinizing granuloma characterized by pseudohyponatremia due to hyperproteinemia

A 57-year-old man presented with multiple pulmonary nodules. Thoracoscopic lung biopsy led to a pathological diagnosis of pulmonary hyalinizing granuloma (PHG) at the age of 39 years. The disease was progressive, refractory to therapy, and necessitated home oxygen therapy 10 years after the diagnosis. Hyponatremia progressed gradually along with lung disease. His serum sodium level was 129 mEq/L but serum osmolality was normal (287 mOsm/kg). Concomitant hyperproteinemia (12.1 g/dL) was attributable to hyperglobulinemia. Direct ion-selective electrode measurement revealed a normal sodium level (137 mmol/L). We herein report a case of PHG characterized by pseudohyponatremia due to hyperproteinemia, an uncommon finding in this rare entity. A left lung transplant was successfully performed, and no pseudohyponatremia was observed. Pseudohyponatremia should be suspected and diagnosed to prevent a misdiagnosis that could lead to complications from inappropriate treatment with sodium supplementation or restriction of drinking water. The direct ion-selective electrode measurement was useful for diagnosing pseudohyponatremia.