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Chest X-ray revealed bilateral interstitial micronodular pattern.
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The chest imaging disclosed a bilateral interstitial micro-nodular pattern (Fig. 1) not revealed in a previous chest X-ray four months ago.
Chest high-resolution computed tomography. Diffuse low attenuation micronodular pattern.
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High-resolution computed tomography (HRCT) of the chest revealed a diffuse centrilobular ill-defined micronodular pattern (Fig. 2). HP typically presented with ill-defined nodular opacities in a centrilobular distribution (Fig. 2) that histologically reflect the presence of cellular bronchiolitis, poorly-formed noncaseating granulomas and bronchiolocentric interstitial pneumonitis with a predominance of lymphocytes (Fig. 3). However, in this Case, the lung biopsy was not necessary as the marked clinical and imaging improvement strongly established a relationship between the use of mesalazine and subsequent lung injury.
Photomicrograph of the histopathologic specimen at transbronchial biopsy shows diffuse, bronchiolocentric lymphocytic inflammatory alveolitis (H and E, x60).
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The transbronchial biopsy findings confirmed lymphocytic alveolitis (Fig. 3).
Resolution of the micronodular pattern after mesalazine discontinuation. A. One month later. B. Three months later.
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There was a gradual improvement of chest imaging (Fig. 4) and pulmonary function tests until full recovery within three months.