Diffuse Lung Disease |

A Rare Case of Diffuse Granulomatous Disease in an Elderly Woman With Endobronchial Involvement and Radiological Findings Resembling Pneumoconiosis FREE TO VIEW

Masahiro Kimura, MD; Emiko Nishikawa, MD; Hibiki Kanda, MD; Mitsuhiro Tada, MD; Shinichi Iwamoto, MD; Kanako Kobayashi, MD; Toru Kadowaki, MD; Toshikazu Ikeda, MD; Shuichi Yano, MD
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Matsue Medical Center, Matsue, Japan

Chest. 2014;146(4_MeetingAbstracts):398A. doi:10.1378/chest.1991868
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SESSION TITLE: ILD Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Sarcoidosis in elderly patients is rare. We present a very elderly asymptomatic woman who developed pulmonary sarcoidosis with endobronchial involvement, whose radiological findings were very difficult to distinguish from pneumoconiosis.

CASE PRESENTATION: A case was 82-years-old female, a housewife. She had no symptoms, but abnormal shadows were detected on a chest radiograph during an annual medical screening. Chest high-resolution computed tomography (HRCT) showed multiple, symmetrical, upper lobe dominant centrilobular small nodules, strikingly similar to Coal Worker’s Pneumoconiosis(CWP). But she had no history of dust inhalation. Physical examination was normal. Whole-body Gallium-67 scintigraphy showed no specific uptake. For differential diagnosis, many laboratory tests were examined, but results were normal except slight elevation of soluble IL-2 receptor. Serial CT scans for several months revealed slightly enlargement of small nodule. So we performed bronchoscopy. Endobronchial findings showed multiple bronchial mucosal nodules and biopsy specimen revealed noncaseous granulomas. To diagnose lung lesion, we performed video-assisted thoracoscopic lung biopsy. Histopathologically, not only noncaseous granulomas with multinucleated giant cells, but also dust-containing nodular fibrotic foci with centrilobular distribution were seen.

DISCUSSION: In our case, an HRCT image showed typical CWP pattern, but she was housewife, needless to say she had no occupational history of dust exposure. Moreover, bronchoscopic findings suggested granulomatous disease. So we decided surgical lung biopsy. Pathological findings were compatible with sarcoidosis and mixed-dust pneumoconiosis. From these findings, we speculated that this case developed sarcoidosis on the basis of pneumoconiosis. Therefore, HRCT image would resemble CWP pattern. Later, by a detailed interview, it became clear that she burnt a briquette indoors on a daily basis. It was thought that she was exposed coal dust for a long time.

CONCLUSIONS: Video-assisted thoracoscopic lung biopsy is safety and useful to reveal pathology of this case. Nevertheless, chest imaging shows typical CWP pattern, it is necessary for us clinicians to consider sarcoidosis. It is emphasized that a detailed interview is important.

Reference #1: Chevalet P, Clément R, Rodat O, et al. Sarcoidosis diagnosed in elderly subjects: retrospective study of 30 cases. Chest. 2004;126(5):1423-1430.

Reference #2: Polychronopoulos VS, Prakash UB. Airway involvement in sarcoidosis. Chest. 2009;136(5):1371-80.

Reference #3: Raval H, Thurm C, Fein A, et al. Initial presentation of sarcoidosis in the very elderly: report of two cases. Chest.2013;144(4_MeetingAbstracts):670A-670A.

DISCLOSURE: The following authors have nothing to disclose: Masahiro Kimura, Emiko Nishikawa, Hibiki Kanda, Mitsuhiro Tada, Shinichi Iwamoto, Kanako Kobayashi, Toru Kadowaki, Toshikazu Ikeda, Shuichi Yano

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