bronchocentric granulomatosis

A diagnosis of exclusion. Pathology: 1) granulomatous & necrotizing replacement of bronchial epithelium 2) tissue eosinophilia in 1/3 of patients Clinical manifestations: asthma (1/3) Laboratory: 1) bronchoscopy 2) biopsy required for diagnosis 3) complete blood count (CBC) with differential - eosinophilia (1/3) 4) positive sputum cultures for Aspergillus (1/3) Radiology: - chest X-ray a) nodular masses (60%) b) pneumonic infiltrates (20%) c) upper lobe & unilateral involvement is more common Differential diagnosis: (similar histopathology with:) 1) Wegener's granulomatosis 2) fungal & mycobacterial infections 3) aspiration 4) rheumatoid lung disease Management: 1) glucocorticoids 2) cyclophosphamide

General

pulmonary infiltrates with eosinophilia (PIE) syndrome granulomatous disease

References

Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 755