기관지 내 결절과 무기폐로 발현한 호산구 육아종증 다발혈관염 1예
Eosinophilic granulomatosis with polyangiitis presenting as an endobronchial nodule and ateletasis: A case report
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, multisystemic, small-to-medium vessel vasculitis characterized by asthma, blood and tissue eosinophilia. Pulmonary manifestations in EGPA are variable; however, endobronchial lesions without parenchymal involvement are rare. Herein, we describe a case of EGPA presenting as atelectasis and endobronchial nodule, which was confirmed by bronchoscopic biopsy. A 43-year-old woman with a history of asthma presented with fever, cough, and sputum. Chest computed tomography scan revealed an endobronchial nodule and total atelectasis in the right middle lobe. Bronchoscopy revealed a whitish nodular lesion blocking the right middle lobe bronchus at the origin of the right middle lobe bronchus. A bronchial mucosal biopsy specimen revealed chronic inflammation with eosinophilic angittis and luminal eosinophilic abscess admixed with mucus. Clinical presentation and pathological results of bronchoscopic biopsy were consistent with EGPA. All symptoms and chest radiographic findings improved after initiating glucocorticoids.
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, multisystemic, small-to-medium vessel vasculitis characterized by asthma, blood and tissue eosinophilia. Pulmonary manifestations in EGPA are variable; however, endobronchial lesions without parenchymal involvement are rare. Herein, we describe a case of EGPA presenting as atelectasis and endobronchial nodule, which was confirmed by bronchoscopic biopsy. A 43-year-old woman with a history of asthma presented with fever, cough, and sputum. Chest computed tomography scan revealed an endobronchial nodule and total atelectasis in the right middle lobe. Bronchoscopy revealed a whitish nodular lesion blocking the right middle lobe bronchus at the origin of the right middle lobe bronchus. A bronchial mucosal biopsy specimen revealed chronic inflammation with eosinophilic angittis and luminal eosinophilic abscess admixed with mucus. Clinical presentation and pathological results of bronchoscopic biopsy were consistent with EGPA. All symptoms and chest radiographic findings improved after initiating glucocorticoids.
참고문헌 (20)
- Churg J, "Allergic granulomatosis, allergic angiitis, and periarteritis nodosa", Am J Pathol, 27, pp.277~301 (1951)
- Gioffredi A, "Eosinophilic granulomatosis with polyangiitis : an overview", Front Immunol, 5, pp.549~ (2014)
- Jennette JC, "2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides", Arthritis Rheum, 65, pp.1~11 (2013)
- Comarmond C, "Eosinophilic granulomatosis with polyangiitis(Churg-Strauss) : clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort", Arthritis Rheum, 65, pp.270~281 (2013)
- Berti A, "Eosinophilic granulomatosis with polyangiitis : the multifaceted spectrum of clinical manifestations at different stages of the disease", Expert Rev Clin Immunol, 16, pp.51~61 (2020)
- Masi AT, "The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome(allergic granulomatosis and angiitis)", Arthritis Rheum, 33, pp.1094~1100 (1990)
- Sinico RA, "Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome", Arthritis Rheum, 52, pp.2926~2935 (2005)
- Kim YK, "Pulmonary involvement in Churg-Strauss syndrome : an analysis of CT, clinical, and pathologic findings", Eur Radiol, 17, pp.3157~3165 (2007)
- Cottin V, "Respiratory manifestations of eosinophilic granulomatosis with polyangiitis(Churg-Straus)", Eur Respir J, 48, pp.1429~1441 (2016)
- Matsushima H, "Multiple tracheobronchial mucosal lesions in two cases of Churg-Strauss syndrome", Respirology, 11, pp.109~112 (2006)
- Hara Y, "Churg-Strauss syndrome with endobronchial eosinophilic vasculitis", Intern Med, 51, pp.3227~ (2012)
- Chen GL, "Endobronchial lesion in eosinophilic granulomatosis with polyangiitis", Iran J Allergy Asthma Immunol, 16, pp.561~564 (2017)
- Boo SJ, "A case of Churg-Strauss syndrome with multiple tracheobronchial mucosal lesions", Tuberc Respir Dis, 65, pp.405~409 (2008)
- Maranini B, "Case report : middle lobe syndrome : a rare presentation in eosinophilic granulomatosis with polyangiitis", Front Immunol, 14, pp.1222431~ (2023)
- Agarwal R, "Allergic bronchopulmonary aspergillosis : review of literature and proposal of new diagnostic and classification criteria", Clin Exp Allergy, 43, pp.850~873 (2013)
- Hebisawa A, "Pathologic reconsideration on allergic bronchopulmonary aspergillosis and mycosis", Nihon Kokyuki Gakkai Zasshi, 36, pp.330~337 (1998)
- Sacoto G, "Lung involvement in ANCA-associated vasculitis", Presse Med, 49, pp.104039~ (2020)
- Polychronopoulos VS, "Airway Involvement in Wegener’s granulomatosis", Rheum Dis Clin North Am, 33, pp.755~775 (2007)
- Guillevin L, "The Five-Factor Score revisited : assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group(FVSG)cohort", Medicine(Baltimore), 90, pp.19~27 (2011)
- Ribi C, "Treatment of Churg-Strauss syndrome without poor-prognosis factors : a multicenter, prospective, randomized, open-label study of seventy-two patients", Arthritis Rheum, 58, pp.586~594 (2008)