TY - JOUR T1 - Spontaneous resolutive pulmonary necrotizing granulomatosis JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2020.1916 VL - 56 IS - suppl 64 SP - 1916 AU - Bastien Weicker AU - Adeline Rosoux AU - Isabelle Gielen AU - Bruno Coulier AU - Richard Frognier Y1 - 2020/09/07 UR - http://erj.ersjournals.com/content/56/suppl_64/1916.abstract N2 - We report the case of necrotizing granulomatosis in a 23-yr-old Caucasian non-smoker healthy female without significant medical history. She initially developed important respiro-dependent migratory back pain. Laboratory test showed mild inflammation syndrome without evidence of auto-immunity. Chest X-ray revealed areas of parenchymal consolidation and chest-computed tomography demonstrated non-specific nodular and non-cavitary retracted infiltrates. Pulmonary function tests were normal. Bronchoscopy with broncho-alveolar lavage showed lymphocytosis (21,3% of the total white cells count) without infection. Surgical lung biopsy was finally performed. Histological analysis revealed necrotizing granulomatosis with vasculitis. The diagnosis of granulomatosis with polyangeitis (GPA formerly known as Wegener’s disease) was initially made. Taking into account the clinical anatomical discrepancy and without evidence of other organ involvement or symptoms, the patient was submitted to a strict follow-up. The initial symptoms and radiologic abnormalities proved spontaneous good evolution without any treatment after a twelve months follow-up. Due to this atypical evolution for GPA, the differential diagnose has been review and surgical biopsy was reviewed by a second team. The final diagnosis was a necrotizing sarcoid granulomatosis (NSG). NSG is a distinctive form of a granulomatous disease with nodular pulmonary lesions associated with subclinical or uncommon features described by Liebow in 1973. It can also be histologically confounded with GPA but the therapeutic decisions and prognosis are different. For this reason, it is important to include this rare entity in the differential diagnosis of necrotizing granulomatosis diseases.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 1916.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -