Presentation
Past history of asthma and sinonasal polyps. Non-smoker. Known stables pulmonary nodules without PET uptake for 3 years. Subacute dyspnea. Peripheral eosinophilia on bloodwork.
Patient Data
Peripheral consolidation / ground glass opacity and solid centrilobular nodules (non cavitated).
Persistent peripheral consolidation / ground glass opacity and solid centrilobular nodules (non cavitated), except the left part which underwent slight changes with now a moderate pleural effusion. There is no obvious migratory consolidation/GGO.
Case Discussion
Chronic consolidation which does persist after standard antibiotics must raise suspicions for inflammatory disease, or lymphoma or bronchioloalveolar carcinoma.
In this patient, the peripheral consolidation/GGO pattern had favored the diagnosis towards chronic eosinophilic lung. However, the additional nodules indicated a likely associated granulomatosis, hence, with all clinical (asthma, sinonasal polyps) and lab elements (peripheral eosinophilia) the most likely diagnosis was eosinophilic granulomatosis with polyangiitis (previously known as Churg-Strauss syndrome).
Organized pneumonia was considered unlikely: lack of migratory elements, no reversed halo sign. Granulomatosis with polyangiitis (Wegner granulomatosis) usually features cavitated nodules and the consolidation does not have a peripheral pattern.