PMC6010641_01
Lung windows from axial chest CT demonstrating diffuse ill-defined centrilobular nodules at the time of presentation (A). A subsequent axial chest CT after treatment with prednisone demonstrated near complete resolution of previously identified centrilobular nodularity (B). Axial CT demonstrating new patchy areas of ground glass attenuation (C).
gr1.jpg
PMC6010641_01_gr1.jpg
fig1
Chest computed tomography (CT) showed diffuse ill-defined, ground glass, centrilobular nodules (Fig. 1A). HP (Fig. 2A/B). He was treated with prednisone with near complete resolution of symptoms and normalization of physiological (FVC 106%, DLCO 88%) and radiological abnormalities (Fig. 1B). FVC and DLCO had declined to 86% and 59%, respectively, and chest CT showed worsening diffuse centrilobular nodularity and mosaic attenuation (Fig. 1C).
Low power (A) and high power views (B) of the video-assisted thoracoscopic surgery lung biopsy in 2008 showing a typical pattern of HP with centrilobular chronic interstitial inflammation and multiple granulomas. Endobronchial biopsy in 2015 showing a small endobronchial granuloma (arrow; C).
gr2.jpg
PMC6010641_01_gr2.jpg
fig2
HP (Fig. 2A/B). He was treated with prednisone with near complete resolution of symptoms and normalization of physiological (FVC 106%, DLCO 88%) and radiological abnormalities (Fig. 1B). Endobronchial biopsies confirmed a diagnosis of HP (Fig. 2C).