Spontaneous resolutive pulmonary necrotizing granulomatosis

We report the case of necrotizing granulomatosis in a 23-yr-old Caucasian non-smoker healthy female without significant medical history. She initially developed important respiro-dependent migratory back pain. Laboratory test showed mild inflammation syndrome without evidence of auto-immunity. Chest X-ray revealed areas of parenchymal consolidation and chest-computed tomography demonstrated non-specific nodular and non-cavitary retracted infiltrates. Pulmonary function tests were normal. Bronchoscopy with broncho-alveolar lavage showed lymphocytosis (21,3% of the total white cells count) without infection. Surgical lung biopsy was finally performed. Histological analysis revealed necrotizing granulomatosis with vasculitis. The diagnosis of granulomatosis with polyangeitis (GPA formerly known as Wegener’s disease) was initially made. Taking into account the clinical anatomical discrepancy and without evidence of other organ involvement or symptoms, the patient was submitted to a strict follow-up. The initial symptoms and radiologic abnormalities proved spontaneous good evolution without any treatment after a twelve months follow-up. Due to this atypical evolution for GPA, the differential diagnose has been review and surgical biopsy was reviewed by a second team. The final diagnosis was a necrotizing sarcoid granulomatosis (NSG). NSG is a distinctive form of a granulomatous disease with nodular pulmonary lesions associated with subclinical or uncommon features described ...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Clinical problems Source Type: research