Romatoid artritli bir hastada nodüler gölgeli eozinofilik pnömoni

Akciğer kanseri ayırıcı tanısını gerektiren nodüllü nadir bir eozinofilik pnömoni olgusunu sunuyoruz. Sekiz yıldır romatoid artrit ve bronşiyal astım tedavisi görüyordu. Akciğer tomografisinde romatizma semptomlarında alevlenme olmamasına rağmen akciğerin her iki üst lobunda yeni gelişen nodüller ve buzlu cam opasiteleri saptandı. Sağ orta lobdan alınan bronkoalveolar lavaj %58,8 eozinofil gösterdi. Hastada bronkoskopi muayenesi sırasında astım atağı geliştiği için nodüler gölge lezyonundan transbronşiyal biyopsi yapılamadı. Prednizolon tedavisinin başlamasından bir ay sonra yapılan göğüs BT taraması, sadece GGO’ların değil, nodüllerin de küçüldüğünü veya neredeyse kaybolduğunu gösterdi. Eozinofilik pnömonili bazı hastalarda akciğer kanserinden ayırt edilmesi gereken nodüller mevcuttur. Bu gibi durumlarda nodül çevresinde GGO’ların varlığı görüntüleme incelemesinde önemli bir bulgu olabilir. Teşhisi doğrulamak için bir doku biyopsisi yapmayı aktif olarak düşünmek arzu edilir. Eozinofilik pnömonili hastalarda bronşiyal astım da olabilir ve bronkoskopi sırasında astım ataklarının başlangıcına dikkat edilmelidir.

Eosinophilic pneumonia with nodular shadows in a patient with rheumatoid arthritis

We report a rare case of eosinophilic pneumonia with nodules, which required a differential diagnosis of lung cancer. She had been treated for rheumatoid arthritis and bronchial asthma for eight years. Although there were no exacerbations of symptoms of rheumatism, newly development of nodules and ground-glass opacities in both upper lobes of the lung were found in the chest CT scan. A bronchoalveolar lavage obtained from the right middle lobe showed 58.8% eosinophils. The transbronchial biopsy from the lesion of the nodular shadow could not be performed because the patient developed an asthma attack during the examination of bronchoscopy. Chest CT scan performed one month after the start of prednisolone treatment showed that not only GGOs but also nodules showed shrinkage or almost disappeared. In some patients with eosinophilic pneumonia, there may be nodules that need to be differentiated from lung cancer. In such cases, the presence of GGOs around the nodule might be an important finding in imaging examination. To confirm the diagnosis, performing a tissue biopsy should be actively considered. Patients with eosinophilic pneumonia might also have bronchial asthma, and attention should be paid to the onset of asthma attacks during bronchoscopy.

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