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Two patients with new granulomatous lung lesions during treatment of Crohn's disease.

Takeda S, Akagi T, Miyazaki H, Kodama M, Yamamoto S, Beppu T, Nagahama T, Matsui T, Watanabe K, Nagata N - Respir Med Case Rep (2014)

Bottom Line: Video-assisted thoracoscopic surgery (VATS) in June 2012 revealed granulomatous lesions.Tuberculosis, fungal infections, drug-induced lung disorder, and sarcoidosis were ruled out as a cause of the granulomatous lesions in both patients.The aetiology was thought to be CD.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Japan ; Department of Respiratory Medicine, Fukuoka University Hospital, Japan.

ABSTRACT
Two patients with granulomatous lung lesions thought to be related to Crohn's disease (CD) are reported. Patient 1 was a 43-year-old man who was diagnosed with CD at age 11 years. He developed a fever in the 38 °C, and a chest X-ray and CT scan showed infiltrates with air bronchograms in the right upper lobe and left lingular segment. Transbronchial lung biopsy (TBLB) revealed granulomatous lesions. Patient 2 was a 76-year-old woman who was diagnosed with CD at age 44 years. Chest CT showed infiltrates and nodular shadows in both lung fields. Video-assisted thoracoscopic surgery (VATS) in June 2012 revealed granulomatous lesions. Tuberculosis, fungal infections, drug-induced lung disorder, and sarcoidosis were ruled out as a cause of the granulomatous lesions in both patients. The aetiology was thought to be CD.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray (left) and CT (right) taken on admission May 2012 reveals infiltrative and small nodular shadow in the right lower and left upper lobes.
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fig4: Chest X-ray (left) and CT (right) taken on admission May 2012 reveals infiltrative and small nodular shadow in the right lower and left upper lobes.

Mentions: Chest X-ray and CT in May 2012 showed new infiltrates in the right lower and left upper lobes (Fig. 4). In June 2012, Video-assisted thoracoscopic surgery (VATS) of the lingula was performed, and histopathology showed an epithelioid cell granuloma with giant cells (Fig. 5). Since acid-fast cultures of the bronchial lavage fluid and lung biopsy tissue were negative, a mycobacterial infection was unlikely. Grocott staining, β-D glucan, and cryptococcal antigen testing were negative, so a fungal infection was also unlikely. Serum ACE was not elevated, the tuberculin reaction was negative, and the pulmonary hilar lymph nodes were not enlarged; thus, sarcoidosis was also ruled out. Drug treatment had not been switched during outpatient follow-up, so drug-induced pneumonia was also unlikely.


Two patients with new granulomatous lung lesions during treatment of Crohn's disease.

Takeda S, Akagi T, Miyazaki H, Kodama M, Yamamoto S, Beppu T, Nagahama T, Matsui T, Watanabe K, Nagata N - Respir Med Case Rep (2014)

Chest X-ray (left) and CT (right) taken on admission May 2012 reveals infiltrative and small nodular shadow in the right lower and left upper lobes.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061430&req=5

fig4: Chest X-ray (left) and CT (right) taken on admission May 2012 reveals infiltrative and small nodular shadow in the right lower and left upper lobes.
Mentions: Chest X-ray and CT in May 2012 showed new infiltrates in the right lower and left upper lobes (Fig. 4). In June 2012, Video-assisted thoracoscopic surgery (VATS) of the lingula was performed, and histopathology showed an epithelioid cell granuloma with giant cells (Fig. 5). Since acid-fast cultures of the bronchial lavage fluid and lung biopsy tissue were negative, a mycobacterial infection was unlikely. Grocott staining, β-D glucan, and cryptococcal antigen testing were negative, so a fungal infection was also unlikely. Serum ACE was not elevated, the tuberculin reaction was negative, and the pulmonary hilar lymph nodes were not enlarged; thus, sarcoidosis was also ruled out. Drug treatment had not been switched during outpatient follow-up, so drug-induced pneumonia was also unlikely.

Bottom Line: Video-assisted thoracoscopic surgery (VATS) in June 2012 revealed granulomatous lesions.Tuberculosis, fungal infections, drug-induced lung disorder, and sarcoidosis were ruled out as a cause of the granulomatous lesions in both patients.The aetiology was thought to be CD.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Japan ; Department of Respiratory Medicine, Fukuoka University Hospital, Japan.

ABSTRACT
Two patients with granulomatous lung lesions thought to be related to Crohn's disease (CD) are reported. Patient 1 was a 43-year-old man who was diagnosed with CD at age 11 years. He developed a fever in the 38 °C, and a chest X-ray and CT scan showed infiltrates with air bronchograms in the right upper lobe and left lingular segment. Transbronchial lung biopsy (TBLB) revealed granulomatous lesions. Patient 2 was a 76-year-old woman who was diagnosed with CD at age 44 years. Chest CT showed infiltrates and nodular shadows in both lung fields. Video-assisted thoracoscopic surgery (VATS) in June 2012 revealed granulomatous lesions. Tuberculosis, fungal infections, drug-induced lung disorder, and sarcoidosis were ruled out as a cause of the granulomatous lesions in both patients. The aetiology was thought to be CD.

No MeSH data available.


Related in: MedlinePlus