Azathioprine
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Pulmonary lymphomatoid granulomatosis: case report A 68-year-old woman developed pulmonary lymphomatoid granulomatosis (PLG) while receiving azathioprine for Crohn’s disease. The woman presented with 1 year history of fatigue, shortness of breath and fatigue. A chest X-ray showed a right pulmonary mass. She had been receiving azathioprine 150 mg/day for Crohn’s disease since 1997 [routes not stated]. She also had been receiving anticoagulation for deep vein thrombosis. Lab testing showed lymphocytopenia. A chest CT scan showed pulmonary mass at the right lung lower lobe. Histopathological examination showed atypical inflammation and necrosis. A cryobiopsy showed necrotizing granulomatosis with inflammation. A bronchoalveolar lavage PCR was positive for Mycobacterium genus and Mycobacterium tuberculosis. She was diagnosed with active lung tuberculosis. She was treated with antituberculars. Chest X-ray showed a volume increase of the tumoral mass. An endobronchial biopsy showed acute necrotizing granulomatous inflammation. Cultures, Ziehl-Neelsen staining and PCR of tuberculosis were also negative. Although a volume increase can occur in the initial treatment phase of tuberculosis, there was doubt on the definitive diagnosis of tuberculosis. The woman was treated with corticosteroids. However, follow-up chest CT scan showed further volume increase with retroobstructive atelectasis. Video-assisted thoracoscopic (VATS) biopsy showed Epstein-Barr virus-positive lymphomatoid granulomatosis. She was finally diagnosed with pulmonary lymphomatoid granulomatosis secondary to azathioprine. The woman was treated with rituximab. At 1 year follow-up, she was doing well with persistent disease remission. Cardinaels N, et al. An atypical case of a pulmonary mass in an immunocompromised patient. Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine 75: 370-374, No. 5, 2 Sep 2020. Available from: URL: http://doi.org/10.1080/17843286.2019.1655232 803504964
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Reactions 3 Oct 2020 No. 1824
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