Abstract
Case description: A 55-year-old previously healthy male presented with complaints of bilateral chest wall pain for the last 4 weeks. Patient denied any history of cough, fever, dyspnea, hoarseness, or any rash. He had smoked a half pack per day for about 30 years. Physical examination was normal as were laboratory studies. Chest CT scan demonstrated a 2.5 cm mass adjacent to the left diaphragm with small satellite nodules. Open lung biopsy did not yield any definite diagnosis. Further workup with MRI of spine, CSF analysis and a para-neoplastic antibody panel were negative. A nerve conduction study demonstrated an axonal polyradiculoneuropathy. Almost a year later a repeat chest and abdominal CT scan showed innumerable bilateral lung nodules and masses. It also showed peculiar mottling of the kidneys. A repeat thoracotomy and lung biopsy showed finding consistent with pulmonary lymphomatoid granulomatosis (EBV positive diffuse large B-cell lymphoma of the lungs).
Discussion: Pulmonary lymphomatoid granulomatosis is an uncommon multi-organ systemic disease with predilection to lungs and characterized by multiple pulmonary nodular lesions with lymphocytic invasion of vascular walls on biopsy. The skin, kidney, and neurologic system may be affected concurrently or independently. Cough and dyspnea are the most common presenting symptoms in patients with lung involvement. Physical examination and laboratory studies are generally non-diagnostic. Chest radiography typically reveals multiple poorly defined nodules and/or masses in the mid- and lower-lung zones; diffuse reticular abnormalities may also be present. Therapy ranges from observation to treatment with prednisone or chemotherapy.
- © 2011 ERS
