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A pulmonary cavitated mass complicating long-standing allergic bronchopulmonary aspergillosis

par Bondue, Benjamin ;Remmelink, Myriam ;Gevenois, Pierre-Alain ;Yernault, Jean Claude ;De Vuyst, Paul
Référence Respiratory Medicine Extra, 1, 3, page (39-42)
Publication Publié, 2005

Article révisé par les pairs

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Résumé :

A cavitated mass of unknown origin was surgically resected in a 64-year-old lady with a 16 years long history of allergic bronchopulmonary aspergillosis without asthma. This lesion had been growing since several months with clinical manifestations of recurrent bronchopulmonary superinfections. The lesion corresponded to a large bronchiectasis with bronchial epithelium still present in some places, but largely destroyed and replaced by a granulation tissue rich in eosinophils with some giant cells. The excavation was filled with a necrotic and haemorragic material containing a few Aspergillus hyphae. The pathological diagnosis was bronchocentric granulomatosis (BCG). BCG is a rare disorder, mostly seen, in asthmatic patients, with bronchopulmonary aspergillosis. The clinical features and non-invasive investigations in this disease are not pathognomonic and do not allow to make a confident diagnosis, which can only be confirmed on a pathological basis. In this case, patient had never suffered from asthma. Moreover, the presentation of BCG as an excavated mass is very uncommon. The surgical procedure was considered as therapeutic. Otherwise, the response of BCG to steroids is excellent and its prognosis better than that of angiocentric granulomatosis. © 2005 Elsevier Ltd. All rights reserved.