PMC5118614_01
a - HRCT Axial. b - HRCT Coronal.
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A high-resolution chest CT demonstrated diffuse upper lobe-predominant bronchiectasis and a small amount of peripheral honeycombing in both upper lobes and scattered tree-in-bud and ground glass opacities (Fig. 1); the bronchiectasis and peripheral honeycombing had progressed slightly compared to a chest CT performed eight years prior and there was no significant pulmonary fibrosis or hilar or mediastinal lymphadenopathy.
a - Right Lung Bronchoscopy. b - Left Lung Bronchoscopy.
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Airway survey unexpectedly revealed diffuse cobblestoning of the endobronchial mucosa distal to the secondary carinas (Fig. 2), so additional endobronchial forceps biopsies and transbronchial biopsies of the right upper lobe were collected for histopathology and the BAL fluid was sent for lymphocyte subset analysis.
a - Endobronchial Granulomas. b - Schaumann Bodies.
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The CD4:CD8 ratio of the BAL fluid returned elevated at 8.9 and the endobronchial biopsies showed well-formed, non-caseating granulomas with chronic inflammation and giant cells with Schaumann bodies (Fig. 3).