PMC6449420_01
Left: CT of the chest obtained around the time of clinical presentation of GLILD, showing mediastinal and hilar lymphadenopathy, peripheral interlobular septal thickening, peripheral consolidation, and ground glass opacities, more prominent on the right lung than left. Right: CT of the chest obtained after treatment with 4 doses of rituximab and azathioprine showing resolution of the lymphadenopathy, consolidation and septal thickening and near resolution of the ground glass opacities.
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F1
A follow-up chest CT scan revealed mediastinal and hilar lymphadenopathy, peripheral interlobular septal thickening, peripheral consolidation, and ground glass opacities (Figure 1). She also had remarkable improvement of the CT scan abnormalities (Figure 1) with the follow up CT scan after completion of therapy demonstrating resolution of all abnormalities.
Right lower lobe lung wedge biopsy using a hematoxylin and eosin stain showing granulomatous lymphocytic Interstitial lung disease with non-caseating granulomatous inflammation with aggregates of small lymphocytes, scattered multinucleated giant cells, scattered foci of organizing pneumonia, interstitial fibrosis focally in the subpleural space but not prominent or diffuse, and airway luminal compromise from adjacent lymphoid hyperplasia.
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F2
The biopsy (Figure 2) showed non-caseating granulomatous inflammation with aggregates of small lymphocytes, scattered multinucleated giant cells, scattered foci of organizing pneumonia, interstitial fibrosis focally in the subpleural space but not prominent or diffuse, and airway luminal compromise from adjacent lymphoid hyperplasia, confirming the diagnosis of GLILD.