PMC8024699_01
Computed tomography images of the multiple lung nodules of necrotizing sarcoid granulomatosis. The first episode of NSG (A), 4 years after the surgical lung biopsy at the time of regular follow-up (B), the second episode of NSG 3 weeks after the regular follow-up (C) and 3 months after the corticosteroid treatment (D).
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A chest computed tomography (CT) image showed multiple nodular shadows (Fig. 1A), so she was referred to our hospital for further evaluation. Four years after her initial diagnosis, she came to our hospital for regular follow-up without any symptoms and abnormal chest CT shadows (Fig. 1B). These shadows consisted of irregular margins and a hypovascular central area, which suggested necrosis (Fig. 1C), although there was no cavity formation. Her symptoms dramatically improved within a week, and the multiple nodular shadows in both lung fields resolved almost completely after three months (Fig. 1D).
Pathological findings of necrotizing sarcoid granulomatosis. (A) The surgical lung biopsy specimen of the first episode showed multiple granulomas (left, Hematoxylin and Eosin (H&E) staining, x40), (B) granulomas with lymphocyte infiltration and necrosis (right, H&E staining, x100). (C) The transbronchial biopsy specimen of the second episode showed multiple granulomas and necrosis (left, H&E staining, x40), (D) granulomas with giant cells and necrosis (right, H&E staining, x100).
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The histological evaluation of the lung specimen showed the infiltration of lymphocytes and granulomas with necrosis (Fig. 2A). The biopsy sample of this lesion revealed infiltration of lymphocytes and granulomas with necrosis (Fig. 2B), which was similar to the surgical lung biopsy obtained four years ago.
(A) Gallium-67 scan image before corticosteroid therapy demonstrated the increased uptake in the multiple lung nodules. (B) Endobronchial nodule of necrotizing sarcoid granulomatosis.
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A Gallium-67 scan image demonstrated the increased uptake in the multiple lung nodules (Fig. 3A). The bronchoscopy revealed a small nodular lesion in the trachea (Fig. 3B).