bronchocentric granulomatosis

Introduction

A diagnosis of exclusion.

Pathology

• granulomatous & necrotizing replacement of bronchial epithelium
• tissue eosinophilia in 1/3 of patients

Clinical manifestations

asthma (1/3)

Laboratory

• bronchoscopy
• biopsy required for diagnosis
• complete blood count (CBC) with differential
  • eosinophilia (1/3)
• positive sputum cultures for Aspergillus (1/3)

Radiology

• chest X-ray
  • nodular masses (60%)
  • pneumonic infiltrates (20%)
  • upper lobe & unilateral involvement is more common

Differential diagnosis

(similar histopathology with:)

• Wegener's granulomatosis
• fungal & mycobacterial infections
• aspiration
• rheumatoid lung disease

Management

• glucocorticoids
• cyclophosphamide

More general terms

• pulmonary infiltrates with eosinophilia (PIE) syndrome
• granulomatous disease