Determining Response to Treatment for Drug-Induced Bronchocentric Granulomatosis by the Forced Oscillation Technique.

Anti-tumor necrosis factor alpha (TNFα) therapy is widely used to treat various inflammatory conditions. Paradoxically, there are several case reports describing the development of bronchocentric granulomatosis treated with TNFα inhibitors, and it is difficult to determine the effect of treatment using conventional spirometry because the lesions are located in small airways. However, it has been reported that the forced oscillation technique (FOT) is useful in the evaluation of small airway disease in bronchial asthma or chronic obstructive pulmonary disease. We performed the FOT to determine the effect of treatment on bronchocentric granulomatosis and found it to be useful. We report the case of a 55-year-old female with ulcerative colitis who was treated with golimumab and who developed bronchocentric granulomatosis as a sarcoid-like reaction to golimumab. She was successfully treated with prednisone, and the treatment efficacy was confirmed by the FOT. The FOT may be useful in the evaluation of small airway disease in bronchocentric granulomatosis. This case may help inform clinicians of the usefulness of the FOT to assess small airway disease in various diseases.

[Pulmonary granuloma in an immunodepressed patient]. / Un granulome pulmonaire chez une patiente immunodéprimée.

INTRODUCTION: Pulmonary alveolar echinococcosis is a rare but potentially severe condition. CASE REPORT: We report the case of a 50-year-old woman suffering from pulmonary alveolar echinococcosis who had had a renal transplant for polycystic liver and kidney disease. A lung opacity was identified radiologically in May 2013. Both broncho-alveolar lavage and bronchial biopsy were uninformative. In January 2014, a follow up CT-scan showed the opacity to be enlarging. A surgical biopsy revealed a giant cell epithelioid granuloma with caseous necrosis suggesting a diagnosis of pulmonary tuberculosis. Antituberculous treatment was started but cultures remained negative. A histological revue was therefore requested in March 2014. This suggested bronchocentric granulmatosis, possibly associated with echinococcosis. This hypothesis was finally confirmed serologically. Treatment for alveolar echinococcosis was begun in June 2014 after consultation with the national reference centre for parasitology. CONCLUSION: Outside endemic areas and in the absence of hepatic involvement pulmonary alveolar echinococcosis can be difficult to diagnose. This case report focuses on the diagnostic criteria and treatment.

Rare case of pulmonary histoplasmosis complicated with bronchocentric granulomatosis in a non endemic area.

BACKGROUND: Pulmonary histoplasmosis is a fungal infection caused by histoplasma capsulatum, rarely diagnosed in non endemic areas and/or immunocompromised patients. Complication of pulmonary histoplasmosis with bronchocentric granulomatosis is extremely rare. CASE REPORT: A 48-year-old man with prolonged fever and nausea was admitted to our hospital. Clinical examination revealed pathological auscultatory sounds to the left lung. Computed tomography was performed and revealed a large solid mass of the left upper lobe, limited pleural and pericardial effusion and calcified lymphadenopathy of mediastinum. A computed tomography guided core biopsy of the lung lesion was performed and three samples were obtained. Culture and polymerase chain reaction (PCR) revealed Histoplasma capsulatum. Histological findings were compatible with bronchocentric granulomatosis. Extended laboratory investigation excluded immunosuppresion. Our patient although immunocompetent was diagnosed with chronic pulmonary histoplasmosis complicated with bronchocentric granulomatosis and treatment with antifungal medication and methylprednisoline started. CONCLUSION: Description of a rare case of chronic pulmonary histoplasmosis in a non endemic area like Greece, with atypical radiological findings, complicated with bronchocentric granulomatosis.

Bronchocentric granulomatosis with extensive cystic lung disease in tuberculosis: An unusual presentation.

Tuberculosis is known to cause both cystic lung disease and bronchocentric granulomatosis (BCG). However, both are rare manifestations of this common disease. We report a case of BCG with extensive cystic lung disease in a young female who presented with fever, weight loss, and recurrent pneumothoraces with respiratory failure. Early diagnosis and treatment are imperative, as appropriate therapy may be life-saving in such cases.

Idiopathic bronchocentric granulomatosis in an asthmatic adolescent.

Bronchocentric granulomatosis in asthmatic patients has been generally considered to be associated with allergic bronchopulmonary aspergillosis and represent a histopathologic manifestation of fungal hypersensitivity. Here we report a case of an idiopathic bronchocentric granulomatosis in a 17-year-old man with a history of asthma. He was admitted to the hospital with a fever and cough, and a chest CT scan showed peribronchial consolidation in the pulmonary parenchyma, which was unresponsive to antibiotic therapy. The pathological findings obtained by video-assisted thoracoscopic lung biopsy revealed necrotizing granulomatous inflammation centered on bronchi and bronchioles and there was no evidence of fungal colonization, resulting in a diagnosis of idiopathic bronchocentric granulomatosis. Systemic corticosteroid therapy led to clinical and radiological recovery. Physicians should take into account the possibility of the idiopathic process in bronchocentric granulomatosis of asthmatic patients.

Corticosteroid monotherapy in a case of bronchocentric granulomatosis with a two-year follow-up.

Bronchocentric granulomatosis (BCG) is a rare disease. Because of the possibility of fungal infection, BCG has usually been treated with corticosteroids and antifungal agent. However, fungi are not detected in all BCG tissues. We report a case of proven BCG by open lung biopsy without fungi in a woman with corticosteroids monotherapy and two-year follow-up.

A Case of Bronchocentric Granulomatosis Associated with Aspergillus / 결핵

Bronchocentric granulomatosis(BCG), first defined in 1973, consists of granulomatous replacement of bronchial mucous membrane, often with heavy eosinophilic reaction within and about the involved bronchi. Etiologic factors are from hypersensitivity reaction for aspergillus, most often from idiopathic form, and in others from being associated with mycobacterium, ecchinococcus, rheumatoid disease, ankylosing spodylitis, and glomerulonephritis. Diagnosis is responsible only for pathologic findings and, in many cases, is confirmed in postoperative findings with misleading for tumor, tuberculosis, infectious or Wegener's granulomatosis. We report a case of bronchocentric granulomatosis associated with aspergillus.