PMC4681958_01
(A) A chest CT scan on admission. Focal consolidation in the left lower lobe is confirmed. (B) A chest CT scan on day 4 after hospitalization. Appearance of consolidation in the right upper lobe and the deterioration of the lung shadow in left lower lobe can be seen.
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A high resolution CT scan demonstrated focal consolidation in the left lower lobe without the evidence of central bronchiectasis or mucoid impaction (Fig. 1A). However, his fever persisted and the re-evaluation of the CT scan on day 4 after hospitalization revealed the exacerbation of left lower lobe consolidation, and new infiltrative opacity appeared in the right upper lobe (Fig. 1B).
Histopathologic examination (Hematoxylin and eosin stains) of lung biopsy specimen. (A) The bronchiolar mucosa is partially replaced by necrotizing granulomatous inflammation. The cellular infiltrate is present in the lumen and the peribronchiolar lesion. (B) Higher magnification photomicrograph shows granulomatous inflammation and remnant of respiratory epithelium.
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The pathology of the resected specimen revealed necrotizing granulomatous inflammation centered on bronchi and bronchioles (Fig. 2).