PMC9359815_01
(A) Lung window of chest CT scan showed lobar GGOs with scattered small patchy consolidation in the right middle lobe (RML). (B) Histopathology showed a mass of foamy cells (blue arrows) and cholesterol clefts (red arrows) in alveolar spaces, scattered multinucleated giant cells (green arrows) and multifocal lymphocyte infiltration in the bronchial wall and interstitial space, accompanied by fibrotic proliferation (H&E Stain 100x Magnification). (C) The chest CT showed lobar consolidation with air bronchogram in RML. (D) A large number of foamy cells (blue arrows) filled in alveoli (H&E Stain 100x Magnification). (E) Granulomatous lesions were scattered in the interstitial space (H&E Stain 100xMagnification), where multinucleated giant cells (green arrows) were surrounded by lymphocytes (yellow arrows). (F) After anti-tuberculosis treatment for 4 months, the opacities in RML were nearly absorbed.
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The patient then received combined administration of amoxicillin and metronidazole for 4 weeks, after which the chest computed tomography (CT) showed that reticulations were superimposed on lobar ground-glass opacities (GGOs), accompanied by small patchy consolidation in the right middle lobe (RML) (Figure 1A). Histopathology of the specimens obtained by transbronchial lung biopsy (TBLB) showed a large number of foamy cells and cholesterol clefts in alveolar spaces with scattered multinucleated giant cells, and multifocal lymphocyte infiltration with fibrotic proliferation in the interstitial space (Figure 1B). RML (Figure 1C). Routine blood, urine and stool examinations, liver and kidney function tests, serum PCT tests and coagulation function studies did not show abnormalities. TBLB still revealed a large number of foamy cells filled in alveoli, accompanied by granulomatous lesions scattered in the interstitial space (Figure 1D and E), no caseous necrosis was found. The tissue samples obtained by TBLB were cultured for bacteria, fungi, and acid-fast bacilli. After 4 months of treatment, chest CT showed that the lung opacities had been absorbed almost completely (Figure 1F).