PMC6630015_01
HRCT scans showing mediastinal and bilateral hilar lymphadenopathy (arrows in A), subpleural nodules (arrows in B), consolidations (triangle in C) and bronchiectasis (arrow in C). Based on these images, no distinction could be made between silicosis and sarcoidosis.
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High-resolution computed tomography (HRCT) showed mediastinal and bilateral hilar lymphadenopathy, subpleural nodules, consolidations, bronchiectasis and fibrotic lesions (Fig. 1).
Open lung biopsy tissue demonstrating non-necrotizing granulomas including birefringent material, as indicated by the asterisk.
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Hence, an open lung biopsy was performed, which showed inflammatory infiltration in the pleura, non-necrotizing granuloma including multinucleated giant cells with hyalinization, and birefringent material in the lung parenchyma (Fig. 2).
PET and HRCT scans before and after 7 months of infliximab therapy. Upper part: PET (A) and HRCT scan (B) 2 months prior to the start of infliximab. At this time, the patient had been on azathioprine therapy for 8 months, and prednisone therapy had been stopped 14 months ago. Lower part: PET (C) and HRCT scans (D) after 7 months of infliximab therapy, showing decreased consolidations.
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F-FDG PET/CT) had decreased (Fig. 3). Forced Vital Capacity (FVC) rose from 1.97 L to 2.35 L (44 and 53% of predicted, respectively) and the diffusing capacity of the lung for carbon monoxide (DLCO) rose from 5.46 mmol/(min*kPa) (54% of predicted) to 6.26 mmol/(min*kPa) (62% of predicted).