PMC3395695_01
High resolution CT scan of the chest, showing diffuse and bilateral hazy increase of lung density ("ground glass" opacity), a left lower lobe consolidation, multiple fine diffuse nodules bilaterally, suggestive for miliary lung disease.
mjhid-4-1-e2012040f1.jpg
PMC3395695_01_mjhid-4-1-e2012040f1.jpg
f1-mjhid-4-1-e2012040
A high-resolution chest CT-scan was carried out, that confirmed a diffuse and bilateral hazy increase of lung density ("ground glass" opacity), especially in the bases, and the presence of diffuse and bilateral multiple micronodules with random distribution, with thickening of the interlobular septa and a left lower lobe consolidation (Figure 1). Because of the concomitant radiological findings documented at CT chest scan, suggestive for miliary lung involvement (Figure 1), a systemic infection caused by BCG was suspected on the basis of the recent intravesical administration of BCG and the worsening patient conditions, despite several days of antibiotic treatment.
Histological examination of bone marrow biopsy showing epithelioid granuloma (100x).
mjhid-4-1-e2012040f2.jpg
PMC3395695_01_mjhid-4-1-e2012040f2.jpg
f2-mjhid-4-1-e2012040
To exclude a relapse of his hematological disease, the patient underwent bone marrow trephine biopsy: no evidence of lymphoma relapse was found in his bone marrow specimen, which instead documented multiple aggregates of epithelioid histiocytes setting up for a granulomatous myelitis (Figure 2); finally, because of a continue and gradual increment of liver function tests, particularly of serum alkaline phosphatase (1124 UI/L), and gamma-glutamyl-transferase (481 UI/L), a liver biopsy was performed, whose histological examination documented the presence of several non-caseating epithelioid granulomas with Langhans giant cells revealing a granulomatous hepatitis (Figure 3).
Histological examination of liver biopsy documented non-caseating epithelioid granuloma in the hepatic tissue (100x).
mjhid-4-1-e2012040f3.jpg
PMC3395695_01_mjhid-4-1-e2012040f3.jpg
f3-mjhid-4-1-e2012040
To exclude a relapse of his hematological disease, the patient underwent bone marrow trephine biopsy: no evidence of lymphoma relapse was found in his bone marrow specimen, which instead documented multiple aggregates of epithelioid histiocytes setting up for a granulomatous myelitis (Figure 2); finally, because of a continue and gradual increment of liver function tests, particularly of serum alkaline phosphatase (1124 UI/L), and gamma-glutamyl-transferase (481 UI/L), a liver biopsy was performed, whose histological examination documented the presence of several non-caseating epithelioid granulomas with Langhans giant cells revealing a granulomatous hepatitis (Figure 3).