Granulomatous lung disease: clinical aspects

ABSTRACT

Introduction

Granulomatous lung diseases (GLD) are heterogeneous group of diseases that can be broadly categorized as infectious or noninfectious. This distinction is extremely important, as the misdiagnosis of a GLD can have serious consequences. In this manuscript, we describe the clinical manifestations, histopathology, and diagnostic approach to GLD. We propose an algorithm to distinguish infectious from noninfectious GLD.

Areas covered

We have searched PubMed and Medline database from 1950 to December 2019, using multiple keywords as described below. Major GLDs covered include those caused by mycobacteria and fungi, sarcoidosis, hypersensitivity pneumonitis, and vasculidities.

Expert opinion

The cause of infectious GLD is usually identified through microbiological culture and molecular techniques. Most noninfectious GLD are diagnosed by clinical and laboratory criteria, often with exclusion of infectious pathogens. Further understanding of the immunopathogenesis of the granulomatous response may allow improved diagnosis and treatment of GLD.

KEYWORDS:

• Granulomatous lung disease
• diagnosis
• mycobacterium tuberculosis
• non-tubercular mycobacterium
• fungal infections
• sarcoidosis
• granulomatous polyangiitis
• chronic beryllium disease
• hypersensitivity pneumonitis and vasculidities

Declaration of interest

M.a Judson is a consultant for Biogen, and has received Institution grant support from Novartis, Mallinckrodt pharmaceuticals. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figure 6. Chest computerized tomography scan displaying diffuse bilateral micronodules in a branching pattern (“tree-in bud pattern”) in a patient with non-tubercular mycobacterial infection. Figure A represent the cross-section of the CT scan and Figure B represent the magnified view of the selected section of CT image.

Figure 7. Chest computerized tomography scan displaying lung micronodules/opacities in a distribution typical for pulmonary sarcoidosis along the bronchovascular bundle and in subpleural locations.

Figure 8. Chest computerized tomography scan displaying ground glass opacities along with the mosaicism (air-trapping) “head and cheese” sign , in a patient with hypersensitivity pneumonitis. Figure A represent the cross-section of the CT scan and Figure B represent the magnified view of the selected section of CT image.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.