Rare case of pulmonary lymphomatoid granulomatosis in conjunction with tuberculosis

Abstract

Rationale:Lymphomatoid granulomatosis is a very rare Epstein-Barr virus-driven lymphoproliferative disease. This disease has high mortality owing to its low incidence in conjunction with nonspecific presentations, which contribute to delays in diagnosis.Patient:An 87-year-old male had a week-long history of intermittent fever and general weakness. A chest radiograph showed multifocal patchy consolidations with nodular lesions.Diagnoses:Open lung biopsy using video-assisted thoracic surgery resulted in a diagnosis of grade III lymphomatoid granulomatosis. Three days after surgery, Mycobacterium tuberculosis complex was identified from the culture of sputum samples collected at admission.Intervention and outcomes:Antituberculous treatment was commenced first. However, after 34 days of antituberculosis medication, the patient died owing to aggravated lymphomatoid granulomatosis.Lessons:This case highlights the fact that rare diseases should also be considered in differential diagnosis, particularly with a common presentation such as multiple lung nodules. Furthermore, a diagnosis of pulmonary lymphomatoid granulomatosis was made after open lung biopsy. To our knowledge, this is the first case of lymphomatoid granulomatosis coexisting with active tuberculosis in the Republic of Korea, where tuberculosis is endemic.

Nocardia cyriacigeorgica infection in a patient with repeated fever and CD4+ T cell deficiency: A case report

“…The lung imaging features of our patient included multiple patchy, nodular and strip-shaped high-density shadows, multiple sputum thrombi and small ground glass density nodules in both lungs. However, manifestations of small or large consolidation shadows, single or multiple nodules, cavities with medium density or above, pulmonary abscess, hilar lymph node enlargement, pleural effusion, empyema, and pleural thickening are also common in fungal infection, pulmonary tuberculosis and other bacterial pneumonia[ 6 - 8 ]. Cough, bloody sputum, chest pain, fever, dyspnoea and empyema are also common in lung cancer patients[ 9 ].…”

Pulmonary lymphomatoid granulomatosis: An uncommon disease but not to be forgotten—a single centre experience

“…Tissue biopsy is generally obtained from lung lesions (due to disease predilection) via video‐assisted thoracoscopic surgery (VATS) or open thoracotomy and less often from skin lesions (if present). Adequate amount of tissue biopsy procurement is crucial to ascertain the diagnosis and grading its severity; transbronchial biopsy or transthoracic needle aspirate may yield small samples inadequate for proper analysis [12].…”